DE5ISJIBD 


NATOMICAL 


K'Prep/Wcb  By 

D.W.Graham,A.M.,M.D. 

MM  O 

J.  Suydam  Knox,  A.M.,MD, 


PROPERTY 

jjt 

Ditsi.net  No.  71 

Lawrencevil'e,  III, 


OAK  ST.  HDSF 


of  the: 

UNIVERSITY 
Of  ILLINOIS 


61  I 
Q76I  p 


Return  this  book  on  or  before  the 
Latest  Date  stamped  below. 


University  of  Illinois  Library 


PRACTITIONERS 
HAND  BOOK 


DESIGNED  TO  ACCOMPANY 


Physician’s  Anatomical  Aid 

(Copyrighted  1884,  1885,  1886,  1888, 
by  Western  Publishing  House) 


PREPARED  BY 


D.  W.  GRAHAM,  A.M.,  M.D. 

AND 

J.  SUYDAM  KNOX,  A.M.,  M.D. 


. / 1 W /7 


yi  i 

G *7  k I p 


PART  FIRST 


THE  SKELETON— BLOOD  FORMATION  AND  CIR- 
CULATION-NERVOUS SYSTEM— SECTIONS 
OF  THE  BODY  AND  ITS  EXTREMI- 
TIES—STRUCTURE  OF  HEAD, 

EYE  AND  EAR. 

BY 


D.  W.  GRAHAM,  A.M.,  M.D., 

Professor  of  Surgery,  Woman’s  Medical  College, 
Surgeon  Cook  County  Hospital. 

Surgeon  Presbyterian  Hospital. 
CHICAGO 


property 

Lwrsirfwl?  T*?>  H. 

DiStn't  ?v3.  71 
Lawrerrcev  *‘k,  i!' 


TABLE  OF  CONTENTS. 


PART  FIRST. 


THE  SKELETON. 

PAGE 

Index  to  Plate,  ........  7 

The  Skeleton  (descriptive) 9 


BLOOD  FORMATION  AND  CIRCULATION. 

Index  to  Plate 14 

Arteries — Veins — Viscera  and  Lymphatics.  Pages  14-15. 

The  Circulation  (descriptive), 15 


NERVOUS  SYSTEM. 

Spinal  Nerves,  . 19 

Cranial  Nerves,  20 

Sympathetic  System , . 20 

The  Spinal  Cord, 21 

(For  the  Brain  see  description  of  the  Head.) 


THE  BODY  AND  EXTREMITIES. 

Indexes  to  Sections 27 

Muscles  of  the  Anterior  Part  of  the  Body — The  Thorax — 
Mediastinum  and  Lungs  — The  Heart  — Interior  of 
Lungs — Abdomen  and  Abdominal  Viscera — Stomach 
and  Intestines — Section  of  Body,  and  Shoulder  and 
Hip  Joints  — Upper  Exremity — Lower  Extremity. 

Pages  27-47. 


5 


THE  HEAD. 

PAGE 

Skull,  Scalp,  etc., 48 

The  Brain,  ....##*>  *52 

The  Eye « 63 

The  Ear,  , 66 


PART  SECOND. 


THE  MALE  GENERATIVE  ORGANS. 

Index  to  Sections, 71 

Male  Generative  Organs  (descriptive),  . . .72 

THE  FEMALE  GENERATIVE  ORGANS. 

Index  to  Sections, 78 

Female  Generative  Organs  (descriptive),  . . .80 


External  Genital  Organs — Internal  Organs  of  Generation 
— Blood  Vessels  of  Uterus  and  Appendages — Develop- 
ment of  the  Ovum.  ....  Pages  80-93. 

Index  to  Sectional  View  of  Female,  . . . 95 

Index  to  Plate  of  Fcetal  Organization,  . . 96 


Letters  and  figures  enclosed  in  parenthesis , in  this  Hand  Book , refer  to 
parts  or  organs  similarly  lettered  or  numbered  on  sections  or  plates. 


THE  SKELETON. 


INDEX  TO  PLATE. 

(1) . — Frontal. 

(2) . — Parietal. 

(3) . — Temporal. 

(4) . — Mastoid  part  of  Temporal. 

(5) . — Nasal. 

(6) .  —Malar. 

(7) . — Superior  Maxillary. 

(8) .  —Teeth. 

(9) . — Inferior  Maxillary. 

(10) . — Cervical  Vertebrae. 

(11) . — Dorsal  Vertebrae. 

(12) . — Lumbar  Vertebrae. 

(13) . — Clavicle. 

(14) . — Scapula. 

(15) . — Sternum. 

(A) .  Manubrium. 

(B) .  Gladiolus. 

(C) .  Ensiform  Appendix. 

(16) . — True  Ribs. 

(17) . — False  Ribs. 

(18) . — Floating  Ribs. 

(19) . — Humerus. 


(20) . — Radius. 

(21) . — Ulna. 

(22) . — Carpus. 

(A) .  Scaphoid. 

(B) .  Semi-lunar. 

(C) .  Cuneiform. 

(D) .  Pisiform. 

(E) .  Trapezium. 

(F) .  Trapezoid. 

(G) .  Os  Magnum. 

(H) .  Unciform. 

(23) . — Metacarpus, 

(24) . — Phalanges. 

(25) . — Sacrum. 

(26) . — Coccyx. 

(27) . — Ilium. 

(28) . — Ischium. 

(29) . — Pubes. 

(30) . — Head  of  Femur. 

(31) . — Neck  of  Femur. 

(32) . — Shaft  of  Femur. 

(33) .— Patella. 

(34) -— Tibia. 

(35) .— Fibula. 

(36) . — Tarsus. 

(A) .  Os  Calcis. 

(B) .  Astragalus. 

(C) .  Scaphoid. 

(D) .  Head  of  Astragalus. 

(E) .  Internal  Cuneiform. 

(F) .  Middle  Cuneiionxi. 

(G) .  External  Cuneiform. 

(H) .  Cuboid. 

(37) . — Metatarsus. 

(38) . — Phalanges. 


8 


THE  SKELETON. 


The  skeleton  consists  of  two  hundred  bones 
excluding  those  of  the  ear  and  the  smaller  sesamoid 
bones.  The  sacrum  and  coccyx,  together,  have  the 
elements  of  nine  vertebrae,  but  are  counted  as  two 
bones.  The  bones  give  outline  to  the  body  and 
support  to  the  soft  parts,  form  cavities  for  the  pro- 
tection of  the  important  organs  and  serve  as  levers 
and  points  of  attachment  for  muscles  in  locomotion, 
and  motion  of  individual  parts. 

As  to  their  form,  bones  are  classed  as  long, 
short,  flat,  and  irregular. 

Long  bones  have  three  sources  of  arterial  sup- 
ply : the  periosteal  vessels  for  the  compact  tissue 
of  the  shaft ; the  nutrient  or  medullary  artery  for 
the  marrow  and  deeper  parts  of  the  shaft ; the  ar- 
ticular arteries  for  the  cancellous  tissue  and  red 
marrow  of  the  extremities.  These  sets  of  vessels 
communicate  freely  with  each  other. 

In  structure,  bone  tissue  is  either  dense  or 
porous.  The  former  is  compact  tissue , and  is  found 
in  the  shaft  of  the  long  bones  and  the  surfaces  of 
all  bones;  the  latter  is  cancellous  tissue , and  forms 
the  expanded  ends  of  the  long  bones  and  the  cen- 
tral part  of  other  bones.  Compact  tissue  is  dis- 
posed in  concentric  layers  {lamellae).  Cancellous 
tissue  is  made  by  these  layers  separating,  diverg- 
ing and  interlacing,  the  fibres  being  disposed  in  the 
tforms  of  arches,  which  give  elasticity  and  strength. 
These  arches  are  always  arranged  with  reference  to 
points  of  pressure  and  traction. 


9 


Except  where  covered  with  cartilage,  bones  are 
surrounded  by  a dense  fibrous  membrane,  the  peri- 
osteum, which  serves  as  a nidus  for  the  subdivision 
and  distribution  of  arteries  to  the  bone  beneath. 
It  sends  a sheath  with  each  vessel.  By  its  under 
layer,  which  is  gelatinous  and  contains  the  osteo- 
blasts, it  contributes  to  the  growth,  nutrition,  and 
repair  of  bones. 

Histologically,  bone  consists  of  bone  spaces 
with  their  contents,  and  the  bone  tissue  proper. 
The  spaces  are  the  medullary  cavities , the  Haversian 
canals , the  lacunae , and  the  canaliculi . The  medul- 
lary cavities  are  the  canals  of  long  bones  which 
contain  yellow  marrow  (ninety-eight  per  cent,  fat), 
and  the  medullary  cavities  of  the  cancellous  tissue, 
which  contain  red  marrow,  which  substance  con- 
tributes to  the  formation  of  the  red  blood  corpus- 
cles. The  medullary  membrane  ( endosteum ) lines 
these  canals  and  spaces. 

The  Haversian  canals  average  i -500th  of  an 
inch  in  diameter.  The  larger  ones  contain  marrow, 
and  all  convey  one  or  more  blood  vessels.  The 
lacunae  are  characteristic  of  true  bone,  as  distin- 
guished from  calcareous  deposits.  They  are  insect- 
like cavities,  between  the  lamellae,  arranged  in  cir- 
cles around  the  Haversian  canals,  oval-shaped,  and 
in  size  1 -2000th  by  1 -6000th  of  an  inch.  Each  one 
contains  a soft,  nucleated  substance  called  a “bone 
corpuscle.”  The  canaliculi  are  the  channels  by 
which  the  lacunae  communicate  with  each  other  and 
with  the  Haversian  canals.  Diameter  i-i4000th 
of  an  inch  and  less.  They  contain,  each,  a minute 


10 


process  of  the  “bone  corpuscle  ” of  the  lacunae. 
This  process  imbibes  nutrient  fluid  from  the  blood 
in  the  Haversian  canals  and  passes  it  on  from  one 
lacuna  or  “ bone  corpuscle  ” to  another — thus  sup- 
plying the  bone  tissue  with  nutrient  material. 

Bone  tissue,  proper,  occupies  all  the  space  be- 
tween the  lacunae  and  canaliculi.  It  is  one-third 
organic  and  two-thirds  earthy  matter.  The  organic 
matter  makes  the  outline  and  forms  a bed  in  which 
the  earthy  matter  is  laid  down  as  minute  osseous 
granules. 

The  embryonic  skeleton  consists,  at  first,  en- 
tirely of  this  animal  matrix,  for  the  most  part  in 
the  form  of  hyaline  cartilage. 

Ossification  begins  by  a deposit  of  bone  gran- 
ules in  the  matrix,  at  certain  points.  Each  point  is 
a “center  of  ossification.”  These  centers  are  defi- 
nite in  number  and  in  their  order  of  succession  for 
each  bone,  but  vary  in  different  bones. 

The  skeleton  begins  to  ossify  in  the  clavicle, 
by  a center  which  appears  the  middle  of  the  second 
month  of  foetal  life. 

The  primary  center  in  a long  bone  is  for  the 
shaft  (diaphysis).  After  the  shaft  is  well  advanced 
in  ossification,  secondary  centers  (epiphyses)  ap- 
pear in  the  articular  ends  of  the  bone.  Still  later, 
other  centers  appear  for  the  processes,  tuberosi- 
ties, etc. 

The  first  epiphysis  to  appear,  and  the  only  one 
present  at  birth,  is  that  of  the  lower  end  of  the 
femur.  This  fact  is  available  in  determining  cer- 
tain medico-legal  questions  about  premature  birth. 


Soon  the  diaphysis  is  separated  from  its  epiphyses, 
only  by  a thin  disc  of  cartilage  (epiphyseal  carti- 
lage). Eventually,  they  unite  and  become  continu- 
ous by  ossification  of  the  disc,  when  the  individual 
has  attained  full  stature.  This  process  is  completed 
in  all  long  bones  by  the  twenty-fifth  year. 

Of  the  epiphyses,  that  one  which  appeals  first 
unites  last.  The  nutrient  artery  runs  toward  that 
epiphysis  which  unites  first.  The  nutrient  arteries 
run  toward  the  elbow  in  the  upper  extremity,  but 
from  the  knee  in  the  lower  limb. 

Bones  derive  their  growth  in  length  from  the 
epiphyseal  cartilages,  but  not  in  equal  degree  from 
the  upper  and  lower.  That  epiphysis  which  ap- 
pears first — being  the  one  from  which  the  nutrient 
artery  runs — contributes  most  to  the  growth  in 
length.  Hence,  in  the  upper  extremity,  the  growth 
in  length  is  derived  mostly  from  the  epiphyses  at 
the  shoulder  and  wrist,  while  in  the  lower  limb 
those  at  the  knee  contribute  most. 

Growth  in  length  is  arrested  if  an  epiphyseal 
cartilage  is  destroyed  by  suppuration,  or  prema- 
turely ossified  by  inflammation.  The  amount  of 
the  permanent  shortening  of  the  limb  resulting,  will 
depend  on  which  cartilage  is  involved,  and  whether 
its  destruction  has  been  complete  or  partial;  and 
if  partial,  whether  on  the  epiphyseal  or  diaphyseal 
face  of  the  cartilage;  for  that  surface  of  the  cartilage 
toward  the  diaphysis  contributes  about  fifteen  times 
more  to  the  growth  in  length  than  does  the  epiphys- 
eal face. 

The  epiphyseal  cartilage,  to  a certain  extent, 


12 


serves  as  a barrier  to  the  extension  of  inflammation 
and  suppuration  from  one  part  to  the  other. 

The  expanded  part  of  the  shaft,  between  the 
end  of  the  medullary  canal  and  the  epiphyseal  car- 
tilage, is  called  the  juxta-epiphyseai  portion  (Ollier), 
and  from  a pathological  and  surgical  standpoint  is 
the  most  important  part  of  the  bone.  It  is  the  seat 
of  the  greatest  physiological  activity  and  prolifica- 
tion,  and  is  the  zone  of  election  for  all  pathological 
processes.  Also,  on  account  of  its  close  relation  to 
a joint,  and  exposed  position,  it  is  most  liable  to 
over-strain,  local  fatigue,  and  other  slight  trauma- 
tisms. Whence  the  explanation  of  the  fact  that 
the  juxta-epiphyseai  portion  of  long  bones,  and  to 
some  extent  the  corresponding  part  of  other  bones, 
is  much  the  most  frequent  point  of  departure  for 
inflammations  and  development  of  neoplasms  dur- 
ing the  period  of  growth.  Also,  at  this  period,  that 
end  of  the  bone  which  contributes  most  to  its 
growth  in  length,  is  the  seat  of  election  for  neo- 
plasm and  inflammatory  lesions.  Hence,  the  more 
frequent  appearance  of  benign  and  malignant 
growths  in  the  epiphyses  at  the  shoulder,  wrist  and 
knee,  than  in  those  at  the  elbow,  hip  and  ankle. 
So  with  all  the  inflammatory  processes,  tubercular, 
or  other  kind.  Though,  on  account  of  certain 
joints  being  more  exposed  to  traumatisms,  the  rule 
is  not  as  invariable  for  inflammatory  processes  as 
for  neoplasms. 


13 


BLOOD  FORMATION  AND  CIRCULATION. 

[Semi- diagrammatic. ) 


INDEX  TO  PLATE. 

ARTERIES. 

(1) . — Carotid  Arteries  which,  with  the  ver- 

tebral, supply  the  head. 

(2) . — Innominate  Artery. 

(3) . — Sub-clavian. 

(4)  (4)  (4). — Arch  of  the  Aorta — ascending,  trans- 
verse and  descending  portion. 

(5)  (5)» — Pulmonary  Arteries,  right  and  left, 
containing  venous  blood. 

(6). — Thoracic  Aorta. 

(7)  (8)  (9). — Gastric,  Hepatic  and  Splenic — 

branches  of  the  Coeliac  Axis,  which 
is  a branch  of 

(10) . — Abdominal  Aorta. 

(11) . — Superior  Mesenteric — to  small  intes- 

tines and  part  of  large. 

(12) . — Renal. 

VEINS. 

(13) . — Vena  Cava  Superior. 

(14)  (14). — Innominate — right  and  left. 

(1 5) . — Sub-clavian. 

(16) . — Jugular. 

(17) . — Pulmonary — containing  arterial  blood. 


14 


08) 

(*9) 

(20) 

(21) 

(22) 

(23) 

(24) 

(25) 

(26) 

(27) 

(28) 

(29) 


— Vena  Cava  Inferior. 
— Hepatic. 

— Gastric. 

— Splenic. 

— Mesenteric. 

— Vena  Portae. 

— Renal  (emulgent). 
— Right  Auricle. 

— Left  Auricle. 

— Right  Ventricle. 

— Left  Ventricle. 

— Thoracic  Duct. 


VISCERA  AND  LYMPHATICS. 
(3°).— Stomach. 


(31) 

(32) 

(33) 

(34) 

(35) 

(36) 

(37) 


—Spleen.  « 

— Liver. 

— Kidney. 

— Duodenum. 

— Ascending  Colon. 

— Descending  Colon. 

— Lymphatics  of  the  Intestines — the 
vessels  being  called  Lacteals ; the 
glands  the  Mesenteric  Glands. 


THE  CIRCULATION. 

The  greater  or  Systemic  Circulation  includes 
the  course  of  the  blood  from  the  left  auricle  (26) 
through  the  left  ventricle  (28),  arch  of  the  aorta  (4), 
the  arteries  to  the  upper  extremities  (3),  those  to 
the  head  (1),  thoracic  aorta  (6)  and  its  branches, 
abdominal  aorta  (10)  with  its  branches,  and  its 


15 


continuation  and  sub-divisions  for  the  lower  ex- 
tremities ; together  with  the  capillaries  and  veins 
corresponding  to  the  areas  of  distribution  of  the 
arteries — the  veins  from  the  head  and  upper  ex- 
tremities joining  to  form  the  superior  vena  cava 
(13), which  opens  into  the  right  auricle — those  from 
the  lower  extremities  and  the  pelvic  and  abdominal 
viscera  join  to  form  the  inferior  vena  cava  (18), 
which  also  opens  into  the  right  auricle. 

The  blood  from  the  intestines  and  digestive 
organs  passes  through  a second  set  of  capillaries, 
in  the  liver,  before  joining  the  general  current  in 
the  vena  cava. 

The  Portal  Circulation — a part  of  the  Systemic 
— includes  the  course  of  the  venous  blood  from  all 
the  organs  of  digestion,  through  the  superior  and 
inferior  mesenteric  veins  and  the  splenic  and  gas- 
tric veins,  which  four  trunks  join  to  form  the  portal 
vein  (23).  This  vein  is  about  four  inches  long  and 
extends  from  behind  the  head  of  the  pancreas  to 
the  transverse  fissure  of  the  liver,  where  it  sub-di- 
vides, and  the  blood,  after  passing  through  a sec- 
ond set  of  capillaries  in  the  liver,  leaves  it  through 
the  hepatic  veins  and  empties  into  the  vena  cava  in- 
ferior. The  portal  system  of  veins  has  no  valves. 

The  lesser  or  Pulmonic  Circulation  includes  the 
course  of  the  blood  from  the  right  auricle  (25) 
through  the  right  ventricle  (27),  through  the  pul- 
monary arteries  (5,  5),  to  the  lungs,  and  its  return 
through  the  pulmonary  veins  (17),  with  a fresh 
supply  of  oxygen,  to  be  again  distributed  through- 
out the  system. 


16 


The  Lymphatic  System  is  an  appendix  of  the 
Vascular  System.  Lymphatic  vessels  begin  in  the 
tissues  as  “ lymph  spaces”  in  connective  tissue,  as 
“ perivascular  spaces,”  and  as  blind  tubules  within 
the  villi  of  mucous  membrane.  These  spaces,  or 
canals,  unite  to  form  tubes  which  unite  again  and 
converge  to  form  the  thoracic  duct  and  the  right 
lymphatic  duct.  In  their  course,  they  pass  through 
(rather  empty  into  and  begin  anew)  numerous  lym- 
phatic glands,  which  are  a collection  of  lymph  folli- 
cles, and  are  of  the  size  of  a pin  head  and  larger. 
In  structure,  these  vessels  resemble  veins  and  have 
many  valves.  The  functions  of  the  lymphatic  sys- 
tem are,  to  sCrve  as  nutrient  channels  in  those  tis- 
sues devoid  of  blood-vessels ; as  a drainage  appa- 
ratus to  collect  and  return  to  the  blood  fluids  which 
have  oozed  through  the  capillaries  to  irrigate  the 
tissues ; and  as  absorbents  and  carriers  of  both 
waste  products  and  food  products.  The  lymphatics 
from  the  intestines  are  the  lacteals , and  during  digest- 
ion, their  contents  are  called  chyme.  The  lymph 
current  is  from  the  periphery  to  the  center  only. 

The  blood  is  the  medium  of  exchange  between 
the  outer  world  and  the  tissues  of  the  body.  It 
conveys  tissue  building  materials  from  without — food 
products  from  the  digestive  tract,  and  oxygen  from 
the  lungs.  The  food  products  are  in  the  form  of 
solutions  and  emulsions,  and  are  absorbed  by  the 
veins  and  lymphatics.  Their  evolution  into  blood 
and  tissue  pabulum  is  carried  on  while  circulating 
in  the  vessels  and  passing  through  the  various 
organs,  as  the  spleen,  liver,  red  marrow  of  bones, 


17 


etc.  The  capillaries  serve  as  the  ultimate  distrib- 
uters of  the  renovated  blood  to  the  tissues,  which 
assimilate  the  new  and  give  up  the  old.  From  the 
intercellular  and  lymph  spaces,  this  blood  fluid, 
charged  with  waste  products,  is  then  taken  up  by 
the  veins  and  lymphatics  and  passed  to  and  through 
various  excretory  organs,  as  the  lungs,  skin,  kid- 
neys, liver,  etc.,  which  separate  the  effete  materials 
to  be  cast  off. 

The  blood  makes  a complete  circuit  of  the 
body,  on  an  average,  in  thirty-two  or  thirty-three 
seconds,  or  during  twenty-seven  heart-beats. 

In  the  adult,  the  blood  constitutes  one-thir- 
teenth part  of  the  weight  of  the  body;  in  the  new- 
born infant,  one-nineteenth. 

Life  is  endangered  by  hemorrhage,  in  propor- 
tion to  the  amount  and  rapidity  of  the  bleeding.  In 
adults,  when  one-half  the  total  blood  is  lost  sud- 
denly, death  is  liable  to  take  place,  and  in  newly 
born  children,  when  a few  ounces  are  lost.  The 
old,  the  young  and  the  adipose  bear  the  loss  of 
blood  badly. 


i > 


NERVOUS  SYSTEM. 


SPINAL  NERVES. 

(A)  — Cervical  Plexus , consisting  of  first  four  cervi- 

cal nerves,  (i),  (2),  (3),  (4). 

(B)  — Brachial  Plexus , consisting  of  (5)  fifth  cervi- 

cal, (6)  sixth  cervical,  (7)  seventh  cervical, 
(8)  eighth  cervical  and  (9)  first  dorsal 
nerves. 

(10) — Second  dorsal.  (11) — Third  dorsal. 
(C Lumbar  Plexus , consisting  of  (12)  the  first 
lumbar, (13)  second  lumbar,  (14)  third  lum- 
bar, (15)  fourth  lumbar,  and  the  dorsi-lum- 
bar  cord. 

(D)  — Sacral  Plexus , consisting  of  (16)  the  fifth 

lumbar,  (17)  first  sacral,  (18)  second  sacral, 
(19)  third  sacral,  and  (20)  part  of  fourth 
sacral. 

(21) — Fifth  sacral.  (22) — Coccygeal. 

(a)  — Phrenic — internal  respiratory. 

(b)  — Long  thoracic — external  respiratory. 

(c)  — Spinal  Cord. 

(d)  — Brain. 

(E)  — Method  of  communication  of  Spinal  Nerves 

with  Sympathetic,  by  a twig  which  is  com- 
posed of  white  matter  from  the  cord  to  the 
ganglion  and  gray  matter  from  the  ganglion 

to  the  cord. 


19 


CRANIAL  NERVES. 


(F)  — Olfactory. 

(G)  — Optic. 

(H)  — Motor  Oculi. 

( I ) — Patheticus. 

(J)  — Tri-facial,  (a) — Ophthalmic  division,  (b) — 

Superior  maxillary  division,  (c)— Inferior 
maxillary  division.  (e,h) — Dental  branches, 
(f) — Branch  to  palate,  (g) — Lingual — spe- 
cial nerve  of  taste  to  tongue,  (j) — Supra- 
orbital branch  of  ophthalmic  division. 

(K)  — Abducens. 

(L)  — Portio  dura — facial  nerve — nerve  of  expres- 

sion. (The  Portio-mollis  not  shown.) 

(M)  — Eighth  nerve.  ( m ) Glosso-Pharyngeal 

branch,  (n) — Pneumogastric  branch,  (p) 
— Spinal  Accessory  branch. 

(N)  — Hypoglossal  nerve. 


SYMPATHETIC  SYSTEM. 

(I) — Cervical  portion:  (i) — Superior,  (2) — Mid- 
dle, (3) — Inferior  Cervical  Ganglia. 

(II) — Thoracic  portion. 

(III)  — Lumbar  portion. 

(IV)  — Sacral  portion. 

(V) — Ganglion  impar. 

The  Cephalic  portion  consists  of  four  pairs  of 
ganglia,  namely,  the  ophthalmic,  the  spheno-pala- 
tine,  the  optic  and  the  sub-maxillary — all  in  con- 
nection with  the  fifth  cranial  nerve,  but  communi- 
cating freely  with  the  other  cranial  nerves. 


20 


The  Sympathetic  System  has  a double 
chain  of  ganglia,  placed  on  each  side  of  the  bodies 
of  the  vertebrae.  In  the  thorax  they  lie  in  front  of 
the  heads  of  the  ribs.  The  ganglia  correspond 
mostly  with  the  vertebrae,  and  the  divisions  of  the 
latter  into  regions.  Each  has  a branch  of  commu- 
nication with  the  spinal  nerves — and  all  with  eaci 
other — composed  of  white  and  gray  matter. 

These  ganglia  are  the  lateral  or  vertebral. 
They  give  off  branches  which  go,  chiefly,  to  the 
thoracic,  abdominal,  and  pelvic  cavities,  forming 
the  collateral  or  pre-vertebral  ganglia,  or  centers, 
named  the  cardiac,  the  solar,  and  the  hypogastric 
plexuses.  From  these  gangliated  plexuses,  branches 
are  again  given  off  to  form  the  terminal  ganglia,  or 
plexuses,  which  surround  and  accompany  all  the 
arteries  of  the  viscera. 

The  sympathetic  has  independent  functions, 
due  to  its  own  gray  matter,  such  as  are  found  in  the 
automatic  ganglia  of  the  heart,  the  mesenteric  plexus 
of  the  intestines,  and  those  for  the  uterus,  ureters, 
and  walls  of  blood-vessels. 

The  dependent  functions  of  the  sympathetic 
are  those  which  inhibit,  augment,  or  modify  im- 
pulses from  the  cerebro-spinal  centers. 


THE  SPINAL  CORD. 

The  spinal  cord  is  that  part  of  the  central  ner- 
vous system  contained  in  the  spinal  canal,  extend- 
ing irom  the  foramen  magnum  to  the  junction  of 
the  first  and  second  lumbar  vertebrae.  It  is  fifteen 


21 


to  eighteen  inches  in  length,  and  has  a cervical 
and  a lumbar  enlargement.  A median  fissure, 
before  and  behind,  divides  it  into  symmetrical 
halves  connected  by  a commissure.  The  gray 
matter  is  in  the  center,  in  the  form  of  two  cres- 
cents, placed  with  their  convexities  together,  giving 
an  anterior  and  a posterior  horn  for  each  lateral 
half.  Around  the  gray  matter,  the  white  conduc- 
ting matter  is  disposed  as  tracts  or  columns,  be- 
tween or  through  which,  the  anterior  and  posterior 
roots  of  the  spinal  nerves  pass  to  or  from  the  horns 
of  the  gray  matter. 

The  spinal  cord  is,  first,  a conducting  medium; 
second,  a center,  or  centers,  for  reflex  action; 
third,  for  automatic  impulses.  It  conducts  out- 
going impulses  as  motor  to  muscles,  vaso-motor,  to 
blood-vessels,  secretory,  to  glands,  trophic,  to  the 
tissues.  The  paths  for  the  out-going  impulses  are, 
chiefly,  the  motor  tracts  from  the  brain — the  direct 
pyramidal  in  the  anterior,  median  part,  and  the 
crossed  pyramidal  in  the  posterior  part  of  the 
lateral  columns.  Fibers  from  these  tracts  pass  to 
and  through  the  cells  of  the  anterior  horn  of  each 
segment  to  the  anterior  roots  of  the  spinal  nerve. 
Hence,  the  motor  tracts  diminish  in  size  from  above 
downwards.  It  also  conducts  in-going  impulses 
causing  general  sensations — cutaneous,  articular, 
muscular,  visual;  special  sensations — tactile,  pain, 
heat,  exciting  reflex  and  automatic  centers.  These 
in-going  impulses  come  from  the  periphery — 
through  the  posterior  roots  of  the  spinal  nerves,  to 
and  through  the  cells  in  the  posterior  horns  of  the 


22 


gray  matter  and  thence  upward  through  the  sensory 
tracts — the  posterior  median  and  the  posterior 
lateral  columns.  The  sensory  tracts  increase  in 
size  from  below  upwards.  Impulses  are  also  con- 
ducted, from  one  segment  to  another,  through  the 
“association  tracts” — the  anterio-lateral  column — 
which  are  of  uniform  size  throughout  the  cord. 

A center  for  a spinal  reflex  is  that  part  of  the 
gray  matter  which  transfers  a stimulus  from  the 
in-going  fibre  of  the  posterior  root  to  the  out-going 
fibres  of  the  anterior  root,  constituting  the  middle 
part  of  the  reflex  arc. 

The  spinal  reflexes  are  the  superficial  or  cuta- 
neous, the  deep  or  tendon  reflexes  and  the  organic . 
The  cutaneous  reflexes  are  the  plantar , the  cre- 
masteric, the  gluteal,  the  abdominal,  the  epigastric  and 
the  inter-scapular.  The  deep  reflexes  are  the  knee- 
jerk,  the  jaw-jerk,  the  ankle  clonus,  and  the  abdo- 
minal reflex.  The  organic  reflexes  are  concerned 
in  the  acts  of  respiration,  circulation,  secretion, 
micturition,  defecation,  etc. 

The  automatic  centers  of  the  cord  are  those 
which  retain  their  activity  after  being  separated 
from  the  medulla,  but,  normally,  are  subject  to  the 
control  of  the  higher  centers  of  the  medulla  and 
cerebrum  and  are  subordinates  to  these.  Ex- 
amples are  the  celio-spinal  center  for  dilating  the 
pupil  (opposite  the  lower  cervical  and  the  upper 
two  dorsal  vertebrae);  the  ano-spinal  center  in  the 
lower  lumbar  segments;  the  vesico-spinal  about 
the  fourth  or  fifth  lumbar;  the  vaso  motor  centers ; 
the  sweat  centers. 


A segment  of  the  spinal  cord  is  that  portion  of 
its  entire  thickness  which  corresponds  to  the  origin 
of  a pair  of  spinal  nerves.  There  are,  hence, 
thirty-one  segments,  each  of  which  has  its  own 
special  functions  as  a nerve  center,  and  also  func- 
tions for  transmitting  and  modifying  impulses  from 
other  segments  and  distant  centers. 

Each  of  the  thirty-one  pairs  of  spinal  nerves 
has  two  roots  of  origin  from  the  cord — a posterior, 
afferent  or  sensory  root,  with  a ganglion  of  gray 
matter,  and  an  anterior,  efferent  or  motor  root. 
The  two  roots  join  at  the  intervertebral  foramen, 
forming  a compound  nerve,  which  then  separates 
into  an  anterior  and  a posterior  division,  or  ventral 
and  dorsal,  each  of  which  has  special  relations — 
the  dorsal  supplying  the  structures  about  the  spinal 
column.  They  are  smaller  than  the  ventral,  except 
those  of  the  first  and  second — the  sub-occipital  and 
the  great  occipital — which  supply  the  back  part  of 
the  scalp. 

The  ventral  divisions  supply  all  the  anterior 
parts  of  the  body.  Those  for  the  limbs  join  and 
intermingle  so  as  to  form  plexuses.  The  ventral 
plexus  for  the  upper  limb  is  derived  from  five 
spinal  nerves,  while  the  lumbo-sacral  plexus  for  the 
lower  limb  is  derived  from  nine. 

As  a general  rule,  a particular  nerve  trunk  sup- 
plies those  parts  which  are  associated  in  function 
— as  the  muscles  which  move  a joint,  (muscular 
branch),  the  joint  itself,  (articular  branch),  the 
skin  about  the  joint  and  insertion  of  the  muscles 
(cutaneous  branch). 


24 


The  roots  of  the  first  cervical  nerve  pass 
slightly  upward  in  the  canal  to  reach  the  foramen 
of  exit.  Those  of  the  second  pass  horizontally, 
while  all  others  pass  downward  in  the  canal  to 
reach  the  foramen  of  exit,  the  spinal  canal  being 
much  larger  than  the  cord. 

The  origins  of  the  nerves  in  the  spinal  cord 
have  the  following  relations  to  the  spinous  processes 
of  the  vertebrae: 

First  cervical — level  of  foramen  magnum. 

Second  cervical — a little  below  occipital  bone. 

Third  cervical — middle  of  space  between  oc- 
cipital bone  and  spinous  process  of  axis. 

Fourth  cervical — spine  of  axis. 

Fifth  cervical — spine  of  third  vertebra. 

Sixth  cervical — between  third  and  fourth 
spines. 

Seventh  cervical — from  spine  of  fourth  to  spine 
of  fifth. 

Eighth  cervical — below  spine  of  fifth  vertebra. 

First  dorsal — spine  of  seventh  cervical  vertebra. 

Second  dorsal — seventh  cervical  to  first  dorsal 
vertebra. 

Third  dorsal — first  dorsal  vertebra  and  below. 

Fourth  dorsal  nerve — second  dorsal  vertebra. 

Fifth  dorsal — third  dorsal  vertebra. 

Sixth  dorsal — fourth  dorsal  vertebra. 

Seventh  dorsal — fifth  dorsal  vertebra  and  above. 

Eighth  dorsal — from  fifth  to  sixth  dorsal  ver- 
tebra. 

Ninth  dorsal — from-  sixth  to  seventh  dorsal 
vertebra 


25 


Tenth  dorsal — from  seventh  to  eighth  dorsal 
vertebra. 

Eleventh  dorsal — from  eighth  to  ninth  dorsal 
vertebra. 

Twelfth  dorsal — from  ninth  to  eleventh  dorsal 
vertebra. 

The  jive  lumbar  nerves  arise  from  between 
spines  of  eleventh  and  twelfth  dorsal  vertebrae. 
The  jive  sacral  and  the  coccygeal  arise  from  level  of 
spine  of  twelfth  dorsal  to  first  lumbar.  The  cord 
terminates  at  lower  border  of  first  lumbar  vertebra. 

Hence,  any  lesion  which  paralyzes  the  neck 
and  upper  limbs  must  be  above  the  fifth  cervical 
vertebra.  The  phrenic  nerve — a part  of  the  third 
and  fourth — is  affected  only  when  the  lesion  is  at 
or  above  the  axis.  A lesion  at  the  sixth  or  seventh 
cervical  paralyses  all  the  intercostal  muscles;  at  the 
third  dorsal,  all  spaces  below  the  third  are  affected; 
at  the  fifth  dorsal  the  abdominal  walls;  at  the 
eleventh  dorsal  the  lumbar  and  sacral  plexuses  be- 
come involved;  at  the  twelfth  dorsal  the  sacral 
plexus  is  paralyzed. 


[ For  the  Brain  see  description  oj  the  Head.~\ 


26 


THE  BODY  AND  EXTREMITIES. 


INDEXES  TO  SECTIONS. 

MUSCLES  OF  THE  ANTERIOR  PART  OF  THE  BODY. 

(d)  Isthmus  of  the  Thyroid  gland,  covering  the 
upper  part  of  the  Trachea. 

(f)  Clavicle. 

(g)  Manubrium  of  Sternum. 

(h)  Central  part  of  Sternum  (Gladiolus). 

(i)  Coracoid  process  of  Scapula. 

(k)  Acromion  process. 

(l)  First  rib.  (m)  Second  rib.  (n)  Third  rib. 
(o)  Fourth  rib.  (p)  Fifth  rib. 

(r)  Head  of  Humerus  (greater  tuberosity). 

(s)  Interclavicular  ligament. 

(t)  Rhomboid  ligament. 

(u)  Aponeurosis  of  External  Intercostals. 

(v)  Acromio-clavicular  ligament. 

(w)  Coraco-acromial  ligament. 

(17)  Platysma-Myoides — a cutaneous  muscle,  the 

upper  end  of  which  is  one  of  the  muscles  of 
expression. 

(18)  Sterno-mastoid  (sternal  portion). 

(19)  Sterno-hyoid. 

(20)  Scalenus  Anticus. 

(21)  Pectoralis  Major. 

(22)  Pectoralis  Minor. 


27 


(23)  Subclavius. 

(24)  Serratus  Magnus — interdigitating  with  (25) 

External  Obliaue  of  the  abdomen. 

(26)  Linea  Alba. 

(27)  Rectus.  (28)  Its  transverse  aponeuroses 

(Linea  Transversae). 

(29)  Pyramidalis. 

(30)  Internal  Oblique. 

(31)  Poupart’s  Ligament,  or  Crural  Arch,  composed 

of  the  thickened  lower  border  of  the  aponeu- 
rosis of  external  oblique.  Below  it,  is  the 
Saphenous  opening — the  outer  end  of  the 
Femoral  canal,  through  which  comes  Fem- 
oral Hernia. 

(32)  External  boundary  (Pillar)  and  (33)  internal 

boundary  (Pillar)  of  (34)  external  abdominal 
ring,  which  is  an  opening  in  the  aponeurosis 
of  external  oblique,  caused  by  divergence  of 
its  fibers.  The  lower  boundary  of  the  ring  is 
the  crest  of  the  Pubes. 

(35)  Internal  abdominal  ring,  the  opening  in  trans- 

versalis  fascia,  situated  a half  inch  above 
Poupart’s  ligament,  and  midway  between 
spines  of  the  Pubes  and  Ilium. 

(36)  Inguinal  canal  for  the  spermatic  cord,  and 

through  which  oblique  inguinal  hernia  makes 
its  way.  Its  roof  is  the  conjoined  lower 
border  of  internal  oblique  and  transversalis 
muscles;  its  floor,  Poupart’s  ligament;  its 
outer  wall,  the  aponeurosis  of  external 
oblique;  its  inner  wall,  the  transversalis 
fascia,  upon  which  the  number  36  is  placed. 


28 


(37)  Border  of  Deltoid  muscle. 

(38)  Coraco-Brachialis. 

(39)  Short  head,  and  (40),  long  head,  of  biceps. 

THE  THORAX. 

(5)  Clavicle. 

(6)  Sternum.  (6)  Manubrium.  (6')  Gladiolus. 

(6")  Ensiform  Cartilage. 

(7)  Ribs. 

(8)  Costal  Cartilages — those  of  the  false  ribs — 

eighth,  ninth  and  tenth — join  that  of  the 
seventh. 

(9)  Sterno- Clavicular  joint  with  ligaments,  and 

' (9')  without. 

(10)  Costo-Sternal  joint  with  ligament. 

(11)  Interclavicular  notch. 

(12)  Internal  and  (12')  External  Intercostal  muscles 

— the  analogues  of  the  oblique  muscles  of 
the  abdomen.  The  external  are  aponeurotic 
from  the  sternum  to  the  ends  of  the  costal 
cartilages,  and  both  are  aponeurotic  from 
the  angles  of  ribs  to  spine.  Between  these 
two  muscular  planes,  in  an  osteo-fibrous 
canal  on  the  under  border  of  each  rib,  are 
the  intercostal  muscles  and  nerves. 

(13  (13')  Costal  (Parietal)  Pleurae. 

MEDIASTINUM  AND  LUNGS. 

(14)  Mediastinum — the  space  from  before  back- 
wards, from  sternum  to  spine,  bounded  lat- 
erally by  the  Pleurae.  Nothing  but  the 
cellulo  adipose  tissue  is  shown.  The  space 
is  divided  into  the  anterior  (from  the  ster- 


29 


num  to  pericardium),  which  contains  the 
remains  of  the  Thymus  gland,  Triangularis 
Sterni  muscle,  left  Brachio-Cephalic  vein 
(crossing  behind  first  part  of  sternum),  Lym- 
phatic glands  and  left  internal  Manunary 
artery  and  vein;  the  middle , which  contains 
the  heart  with  its  large  vessels  and  Phrenic 
nerves ; and  the  posterior , containing  the 
Oesophagus,  Pneumogastric  nerves,  Aorta, 
Thoracic  Duct,  Azygos  vein,  Trachea  and 
Lymphatic  glands. 

(15)  (15)  Upper  and  lower  lobes  of  left  lung. 

(16)  (16)  (16)  Upper,  middle  and  lower  lobes  of 

right  lung. 

INTERIOR  OF  LUNGS. 

(17)  Trachea. 

(A)  Arch  of  Aorta. 

(B)  Pulmonary  artery,  which  begins  in  front  of 

root  of  aorta  and  bi-furcates  under  its  arch, 
giving  a branch  to  each  lung.  It  conveys 
venous  blood  from  the  right  ventricle  to  the 
lungs. 

(C)  Superior  Vena  Cava,  emptying  into  right 

auricle. 

(D)  One  of  Left  Pulmonary  veins,  there  being  two 

on  each  side  which  convey  the  purified 
blood  from  the  lungs  to  the  left  auricle,  by 
four  openings. 

THE  HEART. 

(a)  Right  Auricle. 

(b)  Right  Auricular  appendage. 


30 


(c)  Left  Auricle. 

(d)  Left  Auricular  appendage. 

(e)  Mitral  (Left  Auriculo-Ventricular)  valve. 

(f)  Tricuspid  (Right  Auriculo-Ventricular)  valve, 

(g)  Musculi  Papillares,  with  the  free  ends  of 
which  the  flaps  of  the  valves  are  connected 
by  (h)  the  Chordae  Tendinae. 

(i)  Ventricular  Septum. 

ABDOMEN  AND  ABDOMINAL  VISCERA. 

(14)  Loop  of  large  intestine  (Sigmoid  Flexure  of 

Colon). 

(15)  Bladder. 

(16,  to  the  left).  Great  Omentum  with  Omental 
vessels,  branches  of  the  Gastric. 

(16,  to  the  right).  Transversalis  fascia  and  sub- 
peritoneal  fat,  in  which  are  imbedded  (C') 
the  deep  epigastric  vessels — the  artery,  a 
branch  of  the  external  iliac,  passing  upward 
and  inward  to  reach  the  sheath  of  the  rectus 
muscle,  in  which  it  passes  upward  to  anas- 
tomose with  the  superior  epigastric,  the 
terminal  branch  of  the  internal  mammary. 
In  obstruction  of  the  abdominal  or  thoracic 
aorta,  collateral  circulation  is  carried  on 
largely  by  this  circuit.  The  veins  (the  inner 
one  the  larger)  passing  down,  join  the  ex- 
ternal iliac. 

(17)  Fold  of  Peritoneum  — Median  Vesical  liga- 
ment. (a2)  Parietal  Peritoneum. 

(X)  Spermatic  artery  and  vein. 


31 


THE  LIVER. 


(1)  Right  lobe — lower  surface. 

(2)  Left  lobe. 

(3)  Gall  bladder  distended,  which  normally  pro- 

jects from  under  the  ninth  costal  cartilage. 
When  distended,  and  the  liver  is  enlarged, 
it  approaches  the  umbilicus. 

(4)  Portal  vein  subdividing. 

(5)  Hepatic  veins  uniting  to  join  the  vena  cava  as 

it  lies  in  its  groove  on  posterior  border  oi 
liver. 

(6)  Common  bile  duct,  between  which  and  the 

Portal  vein,  is  the  Hepatic  artery — a branch 
of  the  Coeliac  axis. 

(7)  Hepatic  duct  joining  (8)  the  Cystic  duct,  to 

make  the  common  duct. 

(9)  Neck  of  gall  bladder. 

(10)  Cystic  artery. 

(n)  The  Round  ligament — the  remains  of  the  um- 
bilical artery,  lying  in  the  longitudinal  fis- 
sure between  the  double  fold  of  peritoneum 
(12),  called  the  Falciform  or  Suspensory 
ligament. 

STOMACH  AND  INTESTINES. 

(1')  Oesophageal  opening  of  stomach. 

(3)  Cardiac  end  of  stomach  and  anterior  wall. 

(3')  Rugae  of  mucous  membrane. 

(4)  Pylorus. 

(5)  Beginning  of  Duodenum. 

(7)  Jejunum  and  Ilium. 

(8)  Vermiform  Appendix. 


32 


(9)  Coecum  (Caput  Coli). 

(io)  Ascending  Colon. 

(n)  Hepatic  Flexure. 

(12)  Transverse  Colon. 

(13)  Splenic  Flexure. 

(14)  Descending  Colon,  terminating  in  the  Sigmoid 

Flexure. 

(15)  Bladder,  distended. 

SECTION  OF  BODY,  AND  SHOULDER  AND  HIP  JOINTS 

(1)  Superior  Constrictor  muscle  of  Pharynx. 

(2)  Middle. 

(3)  Inferior. 

(4)  Mucous  membrane  of  Pharynx. 

(5)  Clavicle. 

(6)  Acromio-Clavicular  ligament. 

(7)  Ribs. 

(8)  Acromion  process  of  Scapula. 

(9)  Coraco-acromial  ligament. 

(10)  Tendon  of  long  head  of  Biceps. 

(11)  Capsular  ligament. 

(12)  Anterior  or  inner  surface  of  external  Inter- 

costal muscles. 

(12')  Internal  surface  of  internal  Intercostals. 

(13)  Scapula. 

(14)  Head  of  Humerus,  the  lecser  tuberosity  of 
which,  looks  directly  forward. 

(15')  Surgical  neck  of  Humerus  which  extends  from 
tuberosities  to  lower  border  of  axilla. 

(16)  Coracoid  process  of  Scapula. 

(17)  Articular  Cartilages  of  head  of  Humerus  and 
Glenoid  Fossa. 


33 


(18)  Spleen. 

(19)  Pancreas. 

(20)  Right  kidney. 

(20')  Pyramidal  substance  of  kidney. 

(21)  Supra-renal  Capsule. 

(22)  Pelvis. 

(22')  Calyces. 

(23)  Cortical  substance. 

(24)  Ureter. 

(25)  Transversalis  muscle. 

(26)  Psoas. 

(27)  Iliacus  Internus. 

(28)  Pyriformis,  the  anterior  border  being  continu- 

ous with  the  Coceygeus,  forming  the  floor  of 
the  Pelvis. 

(29)  Sacrum. 

(30)  Sacro-Iliac  ligament. 

(31)  Capsular  ligament  of  hip  joint.  It  is  rein- 

forced, on  the  anterior  surface,  by  (32)  the 
inverted  “Y”  or  Ilio-Femoral  ligament, 
which  arises  from  the  anterior-inferior  spine 
of  Ilium  and  is  inserted  into  (33)  the  inter- 
trochanteric line  of  Femur. 

(34)  Outer  surface  Great  Trochanter. 

(35)  Tuberosity  of  Ischium. 

(36)  Anterior  pubic  ligament. 

(37)  Obturator  membrane. 

(38)  Pectineal  eminence. 

(39)  Crest  of  Ilium,  ending  below  in  the  anterior 

superior  spine. 

(40)  Section  of  rim  of  Acetabulum,  and  articular 

cartilage. 


34 


(41)  Synovial  sac  of  hip  joint. 

(42)  Lesser  Trochanter. 

(A)  Aorta. 

(E)  Inferior  Vena  Cava. 

(F)  Right  and  left  common  Iliac  arteries. 

(F')  Internal  Iliac. 

(F")  External  Iliac. 

(G)  Left  common  Iliac  vein. 

(G')  Left  external  Iliac  vein. 

(H)  Common  Femoral  artery. 

(H')  Superficial  Femoral. 

(H")  Deep  Femoral. 

(l)  Right  Azygos  vein,  which  takes  the  place  of 

the  vena  cava  within  the  chest,  receiving  all 
the  right  intercostal  veins  and  after  arching 
over  the  right  bronchus,  empties  into  the 
superior  vena  cava.  It  communicates  with 
the  inferior  cava  at  its  beginning,  either  di- 
rectly or  indirectly.  It  is  joined  by  the  left 
azygos  about  the  middle  of  the  chest. 

(k)  Subclavian  artery,  terminating  at  the  lower 
border  of  the  first  rib,  in  the  axillary,  which 
terminates  in  (1),  the  brachial,  at  the  lower 
border  of  the  teres  major  muscle. 

(m)  Acrominal  Thoracic. 

(n,  n')  Short  and  Long  Thoracic. 

(o)  Subscapular — giving  off  dorsalis  scapulae. 

(p)  Anterior  and  (q)  Posterior  Circumflex. 

(r)  Superior  Profunda. 

(s)  Branches  of  Transversalis  Colli. 

„ (t)  Intercostal  arteries  and  veins. 

(u)  Splenic  artery. 


35 


(v)  Renal  artery. 

(v')  Lumbar  artery. 

(w)  Renal  vein. 

(x)  Spermatic  artery  and  vein, 

(y)  Inferior  Mesenteric. 

(a')  Lumbar  artery  and  vein. 

(b')  Superior  Gluteal. 

(b2)  Ilio-lumbar. 

(c')  Deep  Epigastric. 

(d')  Circumflex  Iliac. 

(e')  Sciatic  and  Internal  Pudic. 

(f')  External  Circumflex. 

(g')  Obturator. 

UPPER  EXTREMITY. 

PLATE  I. 

Arm — (i)  Acromion  process.  (12)  Fascia  of 
pectoralis  muscle.  (13)  Deep  fascia  of  arm.  (18) 
Deltoid  muscle  covered  with  fascia.  (19)  Pector- 
alis major  muscle.  No  arteries  except  small  mus- 
cular (B)  or  cutaneous  branches  are  shown.  (I) 
Subcutaneous  veins.  (II)  Basilic  vein.  (Ill) 
Cephalic  vein.  (IV)  Median  and  median  cephalic 
veins,  (a)  Supraclavicular  nerve,  (b)  Posterior 
cutaneous,  from  the  circumflex.  (c)  Branches 
from  the  anterior  thoracic,  (d)  Internal  cutaneous, 
(e)  Lesser  internal  cutaneous.  (h)  Musculo-cu- 
taneous. 

Fore- arm  and  Hand — (9)  Deep  fascia.  (10) 
Bicipital  fascia.  (11)  Palmar  fascia.  (11')  Trans- 
verse palmar  ligament.  (12)  Anterior  annular  liga- 
ment. (14)  Paniculus  adiposus  of  the  fingers.  (29) 

36 


Palmaris  Brevis  muscle.  (Ill)  Cephalic  or  radial 
vein.  (IV)  Median  vein.  (V)  Median  Basilic  vein, 
(a)  Branches  of  internal  cutaneous  nerve.  (b) 
Same,  (c)  Branches  of  musculo-cutaneous  nerve, 
(i)  Palmar  branch  of  ulnar  nerve,  (m)  External 
cutaneous  branch  from  musculo-spinal  nerve. 

PLATE  2. 

Arm — (i)  Acromial  end  of  clavicle.  (2)  Cor- 
acoid process  of  scapula.  (3)  Greater  tuberosity 
of  head  of  humerus.  (4)  Lesser.  (5)  Bicipital 
groove.  (8)  Coraco-clavicular  ligament.  (9)  Cor- 
aco-acromial  ligament.  (10)  Capsular  ligament. 
(15)  Bicipital  fascia.  (16)  Pectoralis  major  ten- 
don. (17)  Triceps  muscle.  (19)  Pectoralis  major. 
(20)  Biceps.  (20')  Short  head  of  biceps.  (20") 
Long  head  of  biceps.  (21)  Coraco-brachialis  mus- 
cle. (22)  Brachialis  anticus  muscle.  (23)  Triceps 
muscle.  (A)  Brachial  artery.  (D)  Inferior  pro- 
funda. (HI)  Cephalic  vein.  (IV)  Median  Ce- 
phalic. (V)  Venae  comites — brachial.  (VI)  Be- 

ginning of  Cephalic. 

Fore-arm  and  Hand — (1)  Internal  condyle  of 
humerus.  (9)  Deep  fascia.  (10)  Aponeurosis  of 
biceps  muscle.  ~ (11)  Palmar  fascia.  (12)  Anterior 
annular  ligament.  (13)  Sheaths  of  flexor  tendons 
— circular  and  oblique  fibers.  (15)  Biceps  muscle. 
(15)  Inferior  bicipital  tendon.  (16)  Brachialis  anti- 
cus muscle.  (17)  Triceps.  (18)  Supinator  longus. 
(22)  Flexor  carpi  radialis.  (23)  Palmaris  longus. 
(24)  Flexor  sublimis  digitorum.  (27)  Flexor  car- 
pi ulnaris.  (28)  Pronator  quadratus.  (29)  Palm* 

37 


aris  brevis.  (30)  Abductor  pollicis.  (31)  Oppo- 
nens  pollicis.  (32)  Flexor  brevis  pollicis.  (33) 
Adductor  pollicis.  (34)  Abductor  minimi  digiti. 
(35)  Flexor  brevis  minimi  digiti.  (36)  Lumbricales. 
(B)  Radial  artery.  (G)  Ulnar  artery,  forming  the 
superficial  palmar  arch.  (K)  Digital  branches. 
(N)  Superficial  radial  nerve.  (N")  Dorsal  branch. 

PLATE  3. 

Arm — (1)  Acromio-clavicular  joint.  (2)  Cor- 
acoid process.  (3)  Greater  tuberosity  of  head  of 
humerus.  (4)  Lesser.  (11)  Sheath  of  biceps 

tendon.  (16)  Insertion  of  pectoralis  major  muscle. 
(17)  Insertion  of  deltoid.  (18)  Deltoid.  (20') 
Long  head  of  biceps.  (20")  Short  head.  (21) 
Coraco-brachialis.  (22)  Brachialis  anticus.  (23) 
Triceps.  (A)  Brachial  artery.  (B)  Muscular 

branches.  (C)  Superior  profunda.  (D)  Inferior 
profunda,  (d)  Internal  cutaneous  nerve,  (f)  Me- 
dian nerve,  (g)  Ulnar,  (h)  Musculo-cutaneous. 

Fore-arm  and  Hand — (1)  Internal  condyle.  (2) 
Radius,.  (3)  Ulna.  (4)  Pisiform  bone.  (5)  Unci- 
form bone.  (6)  First  phalanges.  (7)  Second.  (8) 
Third  phalanges.  (15)  Biceps  tendon.  (16)  Brach- 
ialis anticus.  (19)  Extensor  carpi  radialis  brevior. 
(20)  Supinator  brevis.  (24)  Flexor  sublimis  digi- 
torum.  (26)  Flexor  longus  pollicis.  (28)  Pronator 
quadratus.  (31)  Opponens  pollicis.  (32)  Flexor 
brevis  pollicis.  (33)  Adductor  pollicis.  (34)  Ab- 
ductor minimi  digiti.  (35)  Flexor  brevis  minimi 
digiti.  (37)  Interossei.  (A)  Brachial  artery.  (B) 
Radial.  (C)  Superficial  volar  branch.  (D)  Dorsal 

33 


branch.  (E)  Ulnar  artery.  (F)  Interosseous.  (G) 
Superficial  branch  for  superficial  palmar  arch.  (K) 
Digital  branches.  (V)  Venae  comites,  (d)  Median 
nerve,  (d')  Muscular  branch,  (e)  Internal  inter- 
osseous. (g)  Digital  branches,  (k)  Ulnar  nerve, 
(k,  k')  Digital  and  muscular  branches.  (1)  Radial 
nerve,  (n)  Superficial  radial,  (n')  Anterior,  (n") 
Posterior  branches. 

PLATE  4. 

Arm — (2)  Acromion  process.  (2')  Coracoid 
process.  (3)  Clavicle.  (4)  Greater  tuberosity. 
(11)  Capsular  ligament.  (12)  Sheath  of  biceps 
tendon.  (20)  Long  head  of  biceps.  (24)  Internal 
head  of  triceps  muscle.  (24")  External  head  of 
triceps.  (24"')  Middle  or  scapular  head  of  triceps. 
(A)  Axillary  artery.  (B)  Brachial  artery.  (C') 
Acromial  branch  of  transverse  capular  artery.  (D) 
Thoracic  branch  of  brachial  artery.  (E)  Acromial 
thoracic.  (F)  Long  thoracic  branch.  (G,  G') 
Subscapular  artery  and  branches.  (H)  Anterior 
circumflex.  (I)  Posterior  circumflex.  (K)  Mus- 
cular branches.  (L)  Superior  profunda.  (M)  In- 
ferior profunda. 

Fore-arm  and  Hand — (16)  Anterior  ligament, 
elbow  joint.  (18)  External  lateral  ligament.  (18') 
Part  of  orbicular  ligament.  (20)  Interosseous  lig- 
ament. (5)  Styloid  process  of  ulna.  (7)  Styloid 
process  of  radius.  (8)  Pisiform  bone.  (9)  Unci- 
form bone.  (10)  Trapezium.  (11)  Carpo-meta- 
carpal  joint  of  thumb.  (12)  Metacarpal.  (13) 
First  phalanges.  (14)  Second  phalanges.  (15) 


39 


Third  phalanges.  (16,  18,  18')  Ligaments  of  elbow 
joint.  (31)  Pronator  radii  teres.  (32)  Supinator 
brevis  muscle.  (33)  Flexor  carpi  radialis.  (34) 
Pulmonis  longus.  (35)  Flexor  sublimis  digitorum. 
(36)  Flexor  profundis  digitorum.  (37)  Flexor 
longus  pollicis.  (38)  Pronator  quadratus.  (39) 
Adductor  pollicis.  (40)  Abductor  minimi  digiti. 
(41)  Palmar  interosseous.  (B)  Radial  artery.  (D) 
Dorsalis  pollicis.  (G)  Ulnar.  (G')  Ulnar  recur- 
rent. (H)  Interosseous.  (I)  Metacarpal  branch. 
(K)  Termination  of  ulnar  which  is  continued  as 
the  superficial  palmar  arch. 

PLATE  5, 

Arm — (2)  Acromion.  (3)  Clavicle.  (22)  Cor- 

acoid process.  (4)  Greater  tuberosity  of  head  of 
humerus.  (12)  Sheath  of  biceps  tendon.  (19) 
Insertion  of  pectoralis  major.  (20)  Biceps  tendon, 
longhead.  (21)  Short  head.  (22)  Coraco-brachi- 
alis.  (23)  Brachialis  anticus.  (24)  Triceps  mus- 
cle. (A)  Axillary  artery.  (B)  Brachial.  (F) 
Long  thoracic.  (G,G)  Subscapular  and  its  branches. 
(H)  Anterior  circumflex.  (I)  Posterior  circum- 
flex. (K)  Muscular  branches.  (L)  Superior  pro- 
funda. (M)  Inferior  profunda.  (N)  Anastomotica 
magna. 

Fore-ar?n  and  Hand — (2)  External  condyle  of 
humerus.  (4)  Ulna.  (6)  Radius.  (7)  Styloid 
process  of  radius.  (8)  Pisiform  bone.  (9)  Unci- 
form. (10)  Trapezium.  (11)  Trapezoid.  (12) 
Metacarpal.  (13,  14)  Phalanges  of  thumb.  (16) 
Anterior  ligaments.  (20)  Interosseous  ligaments 


40 


of  elbow  joint.  (22,,  23,  24)  Ligaments  of  wrist 
joint.  (30)  Tendon  of  biceps  — insertion.  (31) 
Pronator  radii  teres.  (32)  Supinator  brevis.  (36') 
Tendons  of  flexor  sublimis  digitorum.  (38)  Pro- 
nator quadratus.  (41)  Interosseous.  (A)  Brachial 
artery,  lower  end.  (B)  Radial  artery.  (C)  Super- 
ficialis  volae.  (D)  Dorsal  branch  of  radial.  (D', 
D")  ' Dorsal  branches  to  thumb.  (E)  First  digital 
branch.  (E',  E")  Branches  to  ulnar  and  radial 
sides  of  thumb  (princeps  pollicis).  (F)  Deep 
palmar  branch.  (G)  Ulnar  artery.  (G')  Ulnar 
recurrent  interosseous.  (H')  Anterior  interosseous. 
(I)  Dorsal  branch.  (K)  Ulna  dividing  into  deep 
and  superficial  branches;  the  superficial  joining 
(C)  to  form  (K),  the  superficial  palmar  arch — the 
deep  branch  joining  from  the  radial  to  form  (L'), 
the  deep  palmar  arch.  (M)  Digital  branch  '"o  lit- 
tle finger.  (N)  Common  digital  branches.  (O) 
Interosseous  arteries.  (P)  Digital. 

PLATE  6. 

Arm . — (2)  Coracoid  process.  (3)  Clavicle. 
(4)  Greater  tuberosity  of  humerus.  (9)  Coraco- 
clavicular  ligament.  (10)  Coraco  acromial.  (11) 
Capsular  ligament.  (12)  Sheath  of  biceps  tendon. 
(16)  Anterior  ligament  of  elbow  joint.  (17,  18} 
Lateral  ligaments.  (20)  Long  tendon  of  biceps. 
(18')  Orbicular  ligament.  (A)  Position  of  axillary 
artery.  (D')  Long  thoracic.  (E)  Anterior  thorac- 
ic. (F)  Subscapular.  (G)  Internal  cutaneous 
of  arm.  (G')  Posterior  branch.  (H)  Middle 
cutaneous.  (H')  Ulnar  cutaneous  branch.  (I) 


Musculo  cutaneous  nerve.  (K)  Circumflex.  (L) 
Posterior  cutaneous  of  arm.  (M)  Median  nerve. 
(N)  Ulnar  nerve.  (0)  Muscular  spiral.  (O') 
External  cutaneous  branch. 

Fore-arm  and  Hand — (i)  Internal  condyle  of 
humerus.  (2)  External.  (3)  Internal  part  of 
trochlear  surface  of  humerus.  (4)  Ulna.  (5)  Sty- 
loid process.  (6)  Radius.  (6')  Neck  of  radius. 
(6")  Bicipital  tuberosity.  (7)  Styloid  process  of 
radius.  (8)  Pisiform  bone.  (9)  Unciform  bone. 
(10)  Scaphoid.  (11)  Trapezium.  (12)  Metacarpus. 
(13,  14,  15)  Phalanges.  (19)  Oblique  ligament. 
(20)  Interosseous  membrane.  (21,  24)  Straight 
and  oblique  volar  ligaments.  (22,  23)  Lateral  lig- 
aments. (25,  26)  Anterior  carpal  ligaments.  (27, 
28,  29,  30)  Carpal,  metacarpal  and  transverse  liga- 
ments. (a)  Lesser  internal  cutaneous  nerve,  (b') 
Palmar  branch,  (b")  Ulna  cutaneous  branches, 
(c)  Musculo  cutaneous,  (d)  Median  nerve,  (d') 
Muscular  branches,  (e)  Interosseous  branch,  (f) 
Long  palmar.  (g)  Digital  branches.  (h)  Ulnar 
nerve,  (i)  Dorsal  branch,  (k)  Palmar  branch,  (k') 
Superficial  palmar  branch,  (k")  Digital  branches, 
(k'")  Deep  ulnar  branch.  (1)  Radial.  (1')  Ex- 
ternal cutaneous  branch,  (m)  Posterior  branch, 
(n)  Anterior,  (n')  Dorsal  branch  of  thumb. 

LOWER  EXTREMITY. 

PLATE  I. 

Thigh — (1)  Patella.  (5)  Fascia  lata.  (6)  Cru- 
ral fascia.  (8)  Bursa  patellae.  (I)  Internal  saph- 
enous vein.  (II)  Subcutaneous  veins,  (a)  Externa] 


42 


cutaneous  nerve,  (b)  Branch  of  genito-crural  nerve, 
(c) . Branch  of  inguinal.  (e)  Internal  cutaneous 
nerve.  (f)  Middle  cutaneous. 

Leg — (2)  Internal  malleolus.  (4)  Externa] 
malleolus.  (6)  Deep  fascia  of  the  leg.  (7)  Ante- 
rior annular  ligament.  (8)  Dorsal  fascia  of  the 
foot.  (I)  Subcutaneous  veins.  (II)  Long  saph- 
enous vein,  (a)  Long  saphenous  nerve,  (b)  Mus- 
culo-cutaneous.  (c)  Cutaneous  branches  of  external 
popliteal,  (d)  Internal  cutaneous  of  the  dorsum 
of  foot.  (e)  Middle  cutaneous  of  dorsum.  (g) 
Digital  nerves. 


PLATE  2. 

Thigh — (1)  Patella.  (2)  Internal  condyle  of 
femur,  (3)  of  tibia.  (9)  Sartorius  muscle.  (10) 
Rectus  muscle.  (11)  Vastus  internus.  (12)  Vas- 
tus exterus.  (14)  Pectineus  muscle.  (15)  Ad- 
ductor longus.  (17)  Gracilis.  (I)  Long  saphe- 
nous vein.  (II)  Subcutaneous  veins,  (e)  Branches 
of  internal  cutaneous  nerve. 

Leg — (1)  Tibia.  (2)  Internal  malleolus.  (3) 

Fibula.  (4)  External  malleolus.  (5)  Metatarsal. 
(7)  Anterior  annular  ligament.  (9)  Tibialis  anti- 
cus.  (10)  Extensor  digitorum  longus.  (10')  Per- 
oneus  tertius.  (11)  Extensor  brevis  digitorum. 
(12)  Extensor  hallucis  longus.  (13)  Peroneus 
longus.  (14)  Peroneus  brevis.  (15)  Gastrocne- 
mius. (16)  Soleus.  (17)  Abductor  hallucis.  (18) 
Interosseous.  (A)  Anterior  tibial  artery.  (A') 
Porsalis  pedis  artery.  (Ill)  Deep  veins  of  leg. 


43 


PLATE  3. 


Thigh — (i)  Patella.  (2)  Internal  condyle  of 

femur.  (3)  Of  tibia.  (5)  Deep  fascia.  (9)  Sar- 
torius  muscle.  (10)  Rectus  muscle.  (11)  Vastus 
internus.  (12)  Vastus  externus.  (13)  Psoas  and 
internal  iliac  muscles.  (14)  Pectineus.  (15)  Ad- 
ductor longus.  (16)  Adductor  magnus.  (17)  Gra- 
cilis. (A)  Femoral  artery.  (B)  Deep  femoral. 
(C)  Muscular  branches.  (I)  Internal  saphenous 
vein.  (c)  Branch  of  ilio-inguinal  nerve.  (e) 
Branches  of  internal  cutaneous.  (f)  Middle  cu- 
taneous. (g)  Saphenous  branches,  (h)  Muscular 
branches  of  crural  nerve,  (i)  Musculo-cutaneous 
branches  of  crural  nerve. 

Leg — (1)  Tibia.  (2)  Internal  malleolus.  (4) 
External  malleolus.  (5)  Metatarsal  bones.  (6) 
Fascia.  (7)  Anterior  annular  ligament.  (9)  Tib- 
ialus  anticus  tendon.  (10)  Extensor  longus  digi- 
torum.  (11)  Extensor  brevis  digitorum.  (12) 
Extensor  hallucis  longus.  (13)  Peroneus  longus. 
(14)  Peroneus  brevis.  (15)  Gastrocnemius.  (16) 
Soleus.  (17)  Abductor  hallucis.  (18)  Interosse- 
ous. (b)  Musculo-cutaneous  nerves,  (d)  Dorsal 
cutaneous  of  foot,  (e)  Middle  dorsal  cutaneous, 
(f)  Terminal  branch  of  external  saphenous,  (g) 
Digital  branches,  (h)  Anterior  tibial.  (h')  Internal, 
(h")  Internal  branches  of  same. 

PLATE  4. 

Thigh — (1)  Femur.  (2)  Internal  condyle. 
(3)  External  condyle.  (4)  Patella.  (13)  Gracilis 
muscle.  (14)  Adductor  longus  muscle.  (15)  Ad- 


44 


ductor  brevis.  (16)  Adductor  magnus.  (17)  In- 
sertion of  pectineus  muscle.  (A)  Femoral  artery. 
(B)  Deep  femoral.  (D')  First  perforating  artery. 
(F)  Muscular  branches.  (5)  Tuberosity  of  tibia. 

(7)  Ligamentum  patellae  (middle  part).  (8)  Inter- 
nal lateral  part.  (9)  Internal  lateral  ligament. 
(10)  External  lateral  ligament  (anterior  part). 
(10')  Posterior  part.  (11)  Synovial  capsule. 

Leg  and  Foot. — (1)  Tibia.  (2)  Internal  mal- 
leolus. (3)  Fibula.  (4)  External  malleolus.  (5) 
Tarsus.  (6)  Metatarsus.  (7)  First  phalanges. 

(8)  Second  phalanges.  (9)  Anterior  annular  liga- 

ment. (10)  Interosseous  membrane.  (10')  Tibio- 
fibular ligament.  (10")  Superior  external  malleo- 
lar ligament.  (11)  Internal  lateral  or  deltoid  liga- 
ment. (13)  External  lateral  ligament  (anterior 
part).  (14)  Transverse  metatarsal  ligaments. 

(15)  Capsular  and  lateral  ligaments.  (16)  Pe- 
roneus  longus  and  brevis  muscles.  (17)  Tendons 
of  extensor  longus  digitorum  muscle,  (18)  of  ex- 
tensor longis  pollicis,  (19)  of  tibialis  anticus. 
(20)  Dorsal  interosseous  muscles.  (A)  Anterior 
tibial.  (A')  Dorsalis  pedis. 

PLATE  5. 

Thigh . — (1)  Femur.  (2)  Internal  condyle. 
(3)  External  condyle.  (4)  Patella.  (7)  Ligamen- 
tum patellae.  (8)  Lateral  ligament  of  patella. 

(9)  Internal  lateral  ligament  of  knee  joint.  (10) 
External  lateral  ligament  (anterior  part.)  (10') 
Posterior  part.  (11)  Synovial  capsule.  (16)  Ad- 
ductor magnus.  (17)  Insertion  of  pectineus  mus- 


45 


cle.  (A)  Femoral  artery.  (B)  Profunda  femoris. 
(C)  Descending  branch  of  external  circumflex  ar- 
tery. (D')  First  perforating.  (D")  Second  per- 
forating. (Dr")  Third  perforating.  (E)  Nutrient 
artery  of  femur.  (F)  Muscular  branches.  (G) 
Anastomotica  magna.  (H)  Popliteal.  (I)  Mus- 
cular branches.  (K)  Superior  external  auricular 
(L)  Superior  internal  auricular.  (M)  Middle  ar- 
ticular. (N)  Sural  branches.  (O)  Inferior  exter- 
nal articular.  (P)  Inferior  internal  articular 
branches.  (Q)  Anterior  tibial. 

Leg  and  Foot . — (i)  Tibia.  (2)  Internal.  (3) 
External  malleolus.  (4)  Fibula.  (5)  Tarsus.  (6) 
Metatarsus.  (7)  First  phalanges.  (8)  Second 
phalanges.  (10)  Interosseous  membrane.  (10') 
Tibio  fibular  ligament.  (10")  Superior  external 
malleolar  ligament.  (11)  Internal  lateral  or  del- 
toid ligament.  (12)  Astragalo-scaphoid.  (13) 
Anterior  external  lateral.  (13')  Middle  external 
lateral.  (14)  Transverse  metatarsal.  (15)  Cap- 
sular ligaments.  (A)  Anterior  tibial  artery.  (A') 
Dorsalis  pedis.  (B)  Recurrent  tibial.  (C)  Ex- 
ternal malleolar.  (C')  Internal.  (D)  External 
tarsal.  (D')  Internal  tarsal.  (D")  Anterior  tarsal’. 
(E)  Metatarsal.  (F)  Dorsal  interosseous.  (F') 
Dorsalis  hallucis.  (F")  Deep  plantar  branch  of 
same.  (G)  Posterior  tibial.  (H)  Peroneal.  (H') 
Anterior  peroneal.  (K)  Posterior  internal  malleo- 
lar. (K')  Posterior  external.  (L)  Internal  plantar. 
(L')  Internal  superficial  branch.  (M)  External 
plantar.  (N)  Superior  plantar  arch.  (O)  Sural 
branch. 


46 


PLATE  6. 


Thigh . — (i)  Femur.  (2,  3)  Internal  and  exter- 
nal condyles.  (4)  Patella.  (5')  Tuberosity  of  tibia. 
(6)  Head  of  fibula.  (7)  Ligamentum  patellae.  (8) 
Internal  lateral  part.  (9)  Internal  lateral  ligament  of 
knee.  (10,  10')  External  lateral  ligament.  (11) 
Synovial  capsule,  (a)  Anterior  obturator  nerve, 
(b)  Internal  cutaneous.  (c)  Anterior  internal 
cutaneous,  (d)  Long  saphenous,  (e)  Great  sciatic. 

(f)  External  popliteal  or  peroneal,  (f')  Posterior 
cutaneous  branches  of  leg.  (i)  Internal  popliteal 
nerve,  (k)  Sural  or  long  cutaneous  nerve.  (1) 
Anterior  external  cutaneous. 

Leg  and  Foot. — (Figures  refer  to  same  as  in 
preceding  plate). — (a)  Long  saphenous  nerve,  (b) 
Musculo  cutaneous  or  superficial  peroneal.  (c) 
Anterior  cutaneous  branches,  (d)  Internal  cuta- 
neous branch  of  foot.  (e)  Middle  cutaneous 
branch,  (f)  Posterior  external  cutaneous  of  leg. 

(g)  Digital  branches.  (h)  Anterior  tibial.  (h') 
Internal  branch,  (h")  External  branch,  (i)  Pos- 
terior tibial.  (k)  External  saphenous  branch, 
(k')  External  cutaneous  branch.  (1)  Internal 
plantar,  (m)  External  plantar,  (n)  Digital  plantar. 


47 


THE  HEAD. 


THE  SKULL,  SCALP,  ETC. 

The  skull,  the  bony  part  of  the  head,  consists 
of  the  cranium  and  the  face.  Eight  bones  compose 
the  former  and  fourteen  the  latter.  The  immova- 
ble joints  of  the  skull  are  called  sutures  (5) 
of  which  those  of  the  vertex  are  the  most 
important.  These  sutures  are  best  named  anatom- 
ically, as  the  fronto-parietal  (corona/),  the  inter- 
parietal (sagittal),  occipito-parietal  (lambdoid). 
The  average  thickness  of  the  flat  bones  of  the 
cranium  is  one-fifth  of  an  inch.  The  thickest  parts 
are  the  occipital  protuberance  and  at  the  parietal 
and  frontal  eminences.  The  temporal  region  is  the 
thinnest.  These  flat  bones  have  some  peculiari- 
ties. The  outer  layer  of  “ compact  tissue  ” (ex- 
ternal table)  is  thick  and  tough ; the  inner  (internal 
table),  thin  and  brittle.  The  cancellous  tissue 
(diploe),  most  marked  in  middle  life,  is  “ inter- 
mediate like  a soft  leather  cushion,”  and  is  chan- 
neled for  numerous  large  veins  with  thin  walls. 
The  frontal,  and  part  of  the  temporal  groups  of  the 
diploic  veins,  discharge  into  the  external  veins  of 
the  head,  while  the  occipital,  and  part  of  the  tem- 
poral, discharge  into  the  sinuses  of  the  dura-mater; 
thus  affording  collateral  relief  for  obstructed  circu- 

48 


lation  of  the  brain  by  the  intercommunication  of 
the  internal  and  external  venous  systems.  This 
relation  explains  the  serious  brain  symptoms  which 
are  liable  to  follow* even  a slight  septic  inflamma- 
tion of  the  scalp  and  lesions  of  the  cranial  bones. 
Great  vascularity  characterizes  the  bones  of  the 
cranium  and  face,  as  well  as  all  the  soft  parts  con- 
nected with  them;  hence,  the  relatively  quicker  and 
more  certain  repair  of  injuries,  or  wounds. 

There  are  three  kinds  of  sinuses:  Those  of  the 
dura  mater  for  the  return  of  the  venous  blood  from 
the  brain;  the  cerebral  sinuses,  which  are  inter- 
spaces between  its  lateral  halves  or  other  parts ; 
and  those  in  the  bone,  as  the  frontal,  sphenoidal, 
etc.,  which  contain  air  and  communicate  with  the 
air  passages. 

There  are  five  distinct  strata  of  tissues  cover- 
ing the  cranium:  i.  The  skin.  2.  Dense  fibro-adi- 
pose  tissue,  in  which  are  the  hair  bulbs  and  the 
cutaneous  vessels  and  nerves.  The  arteries,  ad- 
hering to  and  firmly  embedded  in  this  tissue,  when 
cut,  do  not  contract  nor  retract,  and  are  with  diffi- 
culty seized  and  drawn  out  with  forceps;  hence, 
the  free  hemorrhage  in  scalp  wounds  and  the 
trouble  in  arresting  it.  3.  The  occipito-frontalis 
muscle  with  its  aponeurosis,  which  gives  power  to 
move  the  scalp,  and  which  is,  like  the  facial  muscles, 
supplied  by  the  facial  nerve,  and  is  classed  as  one 
of  the  muscles  of  expression.  These  three  struct- 
ures constitute  the  scalp , as  the  term  is  commonly 
used.  4.  Loose  areolar  tissue,  without  fat,  which 
allows  the  “ scalp”  to  glide  freely  on  5.  The 


49 


pericranium  (external  periosteum). 

The  remarkable  vitality  of  the  flaps  in  extensive 
wounds  of  the  scalp  is  due  not  more  to  the  free 
arterial  supply  and  anastomosis  than  to  the  fact 
that  the  arteries  are  carried  with  the  flap  entering 
it  from  its  base. 

Cephalhaematoma  is  a blood  tumor  between 
the  pericranium  and  the  bone  and  is  limited  to  one 
bone.  The  ordinary  effusion  of  blood  (haematoma), 
as  from  a bruise,  is  in  the  loose  areolar  tissue  be- 
tween the  aponeurosis  and  the  pericranium.  It 
is  liable  to  be  diffuse,  but  is  not  often  large,  be- 
cause the  vessels  in  this  tissue  are  small.  Wounds 
of  the  scalp  are  not  more  prone  to  erysipelatous 
inflammation  than  other  wounds.  But  phlegmo- 
nous inflammation  (erroneously  called  erysipelas) 
does  often  occur  if  the  wound  is  not  properly 
treated.  The  loose  areolar  tissue  is  a favorable 
nidus  for  sepsis.  The  skin  heals  rapidly  and  con- 
fines septic  secretions  beneath,  which  diffuse 
rapidly.  Drainage,  keeping  the  angles  of  the 
wound  open,  and  compression,  are  most  important 
in  scalp  wounds. 

(1)  Frontal  bone. 

(2)  Parietal. 

(3)  Occipital. 

(4)  Squamous  portion  of  Temporal. 

(5,  5)  Fronto-parietal  (Coronal)  and  Occipito- 
parietal (Lamboid)  sutures. 

(6)  Malar. 

(7)  External  Auditory  Meatus. 

(8)  Orbicularis  Palpebrarum  muscle. 


50 


(9,  9)  Zygomatici  Major  and  Minor. 

(io)  Masseter  muscle. 

(n)  Orbicularis  Oris. 

(12)  Levator  Menti. 

(13)  Sterno-mastoid. 

(14)  Levator  Auguli  Scapulae. 

(15)  Omo-hyoid — anterior  part. 

(16)  Internal  Jugular  vein. 

(17)  Facial  vein. 

(18)  Temporal  vein. 

(19)  Common  Corotid  artery. 

(20)  Facial  artery. 

(21)  Superficial  Cervical  nerves. 

(22)  Facial  nerve. 

(23)  Supra-maxillary  division. 

(24)  Trachea. 

(25)  Scalp. 

(26)  Skull. 

(27)  Cerebrum. 

(28)  Cerebellum. 

(29)  Spinal  cord. 

(30)  Medulla  Oblongata. 

(31)  Eyeball. 

(32)  Internal  Rectus  muscle 

(33)  Optic  nerve. 

(34)  Internal  surface  of  Malar  bone. 

(35)  Inferior  Maxillary. 

(36)  Anterior  Naris. 

(37)  Inferior  Dental  artery  and 

(38)  Nerve. 

(39?  4°)  Cortex  of  Cerebrum,  showing  convolutions 
of  gray  matter. 

51 

y.  OF  ILL  LIB. 


(40 

(42) 

(43) 

(44) 

(45) 
(46,  47) 


(48) 


(49) 

(50) 

(50 

(52) 

(53) 
.(54) 

(55) 

(56) 

(57) 


(58) 

(58') 


Corpus  Callosum. 

Corpus  Striatum. 

Optic  Thalamus. 

Section  of  Cerebellum. 

Medulla  Oblongata. 

Outer  wall  of  nasal  cavity,  showing  the 
three  turbinated  bones  and  the  meatuses 
— superior,  middle  and  inferior — and  the 
distribution  of  the  olfactory  nerve. 

The  Hard  palate — formed  in  front  by  the 
superior  maxillary,  and  behind  by  the 
palato. 

Pharyngeal  opening  of  Eustachian  tube. 

Pharynx. 

Soft  palate. 

Lateral  portion  of  roof  of  mouth. 

Tongue. 

Sublingual  gland. 

Epiglottis. 

Larynx. 

Junction  of  pharynx  and  oesophagus. 
This  point  is  opposite  the  body  of  the 
fifth  cervical  vertebra  (its  lower  border) 
and  corresponds  with  junction  of  larnyx 
trachea. 

Body  of  fifth  cervical  vertebra. 

Spinal  process  of  vertebra. 


THE  BRAIN. 

The  gray  matter  of  the  brain  is  disposed  as  a 
layer  on  the  outer  surface — the  cortex  with  its  con- 


52 


volutions;  as  circumscribed  convolutions  in  the 
basal  ganglia — corpus  striatum,  optic  thalamus, 
corpora  quadrigemina ; or,  as  the  central  gray  tube 
continued  up  from  the  spinal  cord  through  the 
medulla  and  pons  around  the  iter  to  the  tuber  cin- 
ereum.  The  white  matter  connects  these  parts  in 
various  ways — either  longitudinally  or  transversely 
—the  corona  radiata  (i),  (2),  (3),  (4),  connecting 
the  cortex  with  the  basal  ganglia ; the  commissural 
fibers  (c,  c)  connecting  corresponding  parts  of  the 
two  hemispheres  ; the  association  fibers  (a,  a)  con- 
necting different  areas  of  the  same  part;  the  longi- 
tudinal bundle  of  fibers,  as  pyramids,  tracts,  etc., 
connecting  the  gray  matter  of  the  spinal  cord  with 
all  the  brain  centers. 

The  ventricles  of  the  brain  are  the  spaces  be- 
tween the  different  ganglia  or  parts. 

DIAGRAM  OF  THE  RELATIONS  OF  THE  CENTRAL 

GANGLIA  OF  GRAY  MATTER  TO  EACH  OTHER 
AND  TO  THE  SPINAL  CORD. 

(C,  C). — Cortical  gray  matter  of  the  cere- 
brum. 

(C,  S). — Corpus  striatum. 

(N,  L). — Lenticular  nucleus — the  extra-ven- 
tricular  part  of  former. 

(T,  o). — Optic  thalamus. 

(V). — Corpora  quadrigemina. 

(P). — Peduncle  of  cerebrum. 

(H). — Tegmentum — the  upper  part  of  the  pe- 
duncle. 

(p). — Crusta — under  part  of  peduncle. 


53 


(i,  i). — Corona  radiata  of  corpus  striatum. 

(2,  2). — Corona  radiata  of  lenticular  nucleus. 
(3,  3)* — Corona  radiata  of  the  optic  thalamus. 
(4,  4). — Corona  radiata  of  the  corpora  quad- 
rigemina. 

(5). — Direct  fibers  to  cortex. 

- (6,  6). — Fibers  from  corpora  quadrigemina  to 
tegmentum. 

(7). — Fibers  of  the  optic  thalamus. 

(m). — Same  fibers  continued. 

(8,  8). — Fibers  from  corpus  striatum  and  nu- 
cleus to  crusta. 

(M). — Same  continued  in  cord. 

(S,  S). — Course  of  sensory  fibers. 

(a,  a) — Association  system  of  fibers. 

(c,  c). — Commissural  fibers. 

(R). — Transverse  section  of  spinal  cord. 

(v,  W). — Anterior  root.  r 
(h,  W). — Posterior  root. 

LEFT  SIDE  OF  THE  BRAIN  SHOWING  THE  FISSURES, 
CONVOLUTIONS  AND  MOTOR  AREAS,  AND 
THEIR  RELATION  TO  THE  SKULL 
BONES  AND  THEIR 
SUTURES. 

The  outer  surface  of  the  cerebral  hemispheres 
is  divided  into  four  lobes  by  the  fissure  of  Sylvius, 
the  fissure  of  Rolando,  and  the  parieto-occipital 
fissure.  These,  from  their  depth,  regularity,  and 
early  development,  are  called  primary  fissures. 
The  frontal  lobe  is  that  part  anterior  to  the  fissure 
of  Rolando.  The  parietal  lobe  is  between  the  fis- 


54 


sure  of  Rolando  and  the  parieto-occipital  fissure. 
The  occipital  lobe  consists  of  that  part  of  the 
hemisphere  below  the  parieto-occipital  fissure. 
The  temporo-sphenoidal  lobe  is  that  part  which 
occupies  the  middle  fosse  of  the  skull,  and  is 
bounded  before  and  above  by  the  fissure  of  Sylvius 
and  joins  the  occipital  behind.  The  Island  of  Reil 
or  central  lobe — the  fifth  primary  lobe — lies  deep 
in  the  fissure  of  Sylvius,  but  does  not  show  on  the 
surface.  Each  of  these  primary  lobes  is  sub-di- 
vided by  secondary  fissures,  of  more  or  less  regu- 
larity, into  secondary  lobules  called  convolutions. 

(K  i). — Bregma. 

(K  2). — Parieto-frontal  suture,  crossing  tem- 
poral ridge — the  dotted  semi-circular  line. 

(K  3). — Anterior  inferior  angle  of  parietal, 
joining  the  sphenoid  and  frontal  bones,  and  where 
the  suture  begins. 

(M). — Point  on  squamous  suture  crossed  by 
a perpendicular  line  from  depression  in  front  of  the 
meatus  to  the  bregma. 

(L  i,  L 2). — Parieto-occipital  fissure. 

The  numbers  (i)  to  (14)  and  the  letters  (a), 
(b),  (c),  (d),  refer  to  cortical  centers  and  are  the 
same  as  in  description  of  following  diagram. 

(S). — Main  part  of  fissure  of  Sylvius,  separating 
the  frontal  from  the  tempero-sphenoidal  lobes. 
It  divides  into  an  ascending,  or  perpendicular,  and 
a horizontal  ramus.  The  latter  is  bisected  at  the 
point  (M). 

(C). — Fissure  of  Rolando  or  central  sulcus. 

(A). — Ascending  frontal  convolution. 


55 


(B). — Ascending  parietal  convolution. 

(f  i). — First  or  superior  frontal  fissure,  cor- 
responding to  a curved  line  drawn  parallel  to  the 
longitudinal  fissure  beginning  at'  the  supra-orbital 
notch. 

(f  2). — Second  or  inferior  frontal  fissure,  a 
little  below,  but  nearly  corresponding  to  the  tem- 
poral ridge. 

(f  3) — Pre-central  fissure — sometimes  called 
an  extension  of  the  ascending  ramus  of  the  fissure 
of  Sylvius.  It  corresponds  to  the  parieto-frontal 
suture  and  is  frequently  joined  at  right  angles  by 
(f  1)  the  first,  (f  2)  second,  and  (f  3)  third  frontal 
convolutions. 

(i,  p) — Inter-parietal  suture  separating  (P  1) 
superior  parietal  lobule  or  convolution  from  (P  2) 
inferior  parietal  lobule  or  convolution.  The  upper 
part  of  (P  2)  is  the  supra-marginal  convolution  or 
gyrus,  and  the  lower  and  posterior  part  is  the  an- 
gular convolution  or  gyrus. 

(c,  m) — End  of  calloso-marginal  fissure. 

(P,  o) — Parieto-occipital  fissure — the  division 
between  the  parietal  and  occipital  lobes — and  nearly 
corresponding  to  the  beginning  of  the  occipito- 
parietal suture.  ' 

(Li,  L2) — Points  on  the  parieto-occipital  su- 
ture. 

(o) — Transverse  occipital  fissure. 

(o  2) — Inferior  or  longitudinal  occipital  fissure. 

(Oi,  O2,  O3) — First,  second  and  third  occipi- 
tal convolutions. 

(t  1) — First  temporo-sphenoidal  fissure — near- 
56 


ly  parallel  with  horizontal  branch  of  fissure  of  Syl- 
vius, and  nearly  mid-way  between  it  and 

(t  2)— Second  temporo-sphenoidal  fissure. 

(Ti,  T2,  T3) — First,  second  and  third  tem- 
poro-sphenoidal convolutions. 

DIAGRAM  OF  UPPER  SURFACE  OF  THE  BRAIN. 

This  plate  shows  three  of  the  primary  lobes:  the 
frontal , with  its  four  sub-divisions — the  first,  sec- 
ond, third,  and  ascending  frontal  convolutions;  the 
parietal , with  its  four  sub-divisions — the  ascending, 
superior,  supra-marginal,  and  angular  convolutions; 
the  occipital , with  its  three  convolutions — only  the 
first  and  second  appearing. 

The  figured  and  lettered  circles  are  the  corti- 
cal areas,  mapped  out  on  the  surface,  correspond- 
ing to  various  centers  which  have  been  located  by 
the  experiments  and  observations  of  Farrier  and 
others. 

The  motor  areas  in  general  are  in  close  rela- 
tion to  the  fissure  of  Rolando,  especially  in  the  as- 
cending frontal  and  parietal  convolutions. 

(1) — On  superior  parietal  lobule  : centers  for 
advancing  opposite  leg  and  foot,  as  in  walking. 

(2,  3,  4) — Around  upper  end  of  fissure  of  Ro- 
lando : centers  for  complex  movements  of  arms, 
legs  and  trunk  combined,  as  in  climbing  and  swim- 
ming. 

(a,  b,  c,  d) — On  the  ascending  parietal  con- 
volutions : the  centers  for  fingers  and  wrist — pre- 
hensible. 

(5) — Posterior  end  of  first  frontal  convolution: 
for  reaching  out  the  arm  and  hand. 


57 


(6) — On  the  ascending  frontal  : for  flexing  and 
supinating  fore  arm  and  hand — especially  for  the 
biceps. 

(7,  8) — Middle  of  same  convolution : for  ele- 
vation and  depression  of  the  angle  of  the  mouth. 

(9,  10) Broca’s  convolution — the  aphasiac 

region : for  movements  of  lip  and  tongue. 

(11)  — Between  (10)  and  lower  end  of  the  as- 
cending parietal : retraction  of  angle  of  mouth — 
the  platysma. 

(12)  — Posterior  parts  of  first  and  second  frontal 
convolutions : for  lateral  movements  of  head  and 
eyes,  elevation  of  eyelids  and  dilatation  of  pupil. 

(13,  i3r) — Supra-marginal  and  angular  convo- 
lutions : centers  of  vision,  with  which  the  occipital 
lobe  is  also  concerned. 

(14) — On  superior  tempero-sphenoidal : for 
center  of  hearing. 

The  center  for  smell  is  in  the  hippocampal 
lobule,  not  shown  on  the  surface.  Near  by  is  the 
center  of  taste. 

The  center  for  sense  of  touch  is  in  the  hippo- 
campal region  and  gyrusfornicatus. 

CRANIO -CEREBRAL  TOPOGRAPHY  LANDMARKS  AND 

RULES  FOR  LOCATING  ON  THE  SKULL  OF 
THE  LIVING  SUBJECT,  THE  POSITION 
OF  THE  LOBES,  PRINCIPAL  BLOOD- 
VESSELS, FISSURES  AND  CON- 
VOLUTIONS OF  THE 
BRAIN. 

(L) — Lower  border  of  orbit. 

58 


(E)-— External  angular  process. 

(T) — Beginning  of  temporal  ridge. 

(S) — Supra-orbital  notch. 

(G) — Glabeiia — prominence  just  above  root  of 
nose. 

(B) — Bregma — junction  of  inter-parietal  and 
fronto-parietal  sutures. 

(-|-) — Center  of  parietal  protuberance. 

(O) — Occipital  protuberance. 

(M) — Posterior  border  of  mastoid  process. 

(D) — Depression  in  front  of  external  auditory 
meatus. 

(HL) — Horizontal  base  line  from  lower  border 
of  orbit  through  middle  of  meatus  to  the  occiput. 
Plain  lines  indicate  position  of  primary  fissures. 
Dotted  lines,  the  secondary  fissures  or  sulci. 

(a,  b) — Imaginary  lines  which  arbitrarily  mark 
the  division  between  the  parieto-occipital  and  tem- 
poro-sphenoidal  lobes. 

The  longitudinal  fissure  corresponds  to  the 
curved  line  (G  O)  and  separates  the  hemispheres 
of  the  cerebrum. 

The  transverse  fissure  (OD)  is  represented  by 
a line  from  the  occipital  protuberance  to  the 
meatus  and  corresponds  to  the  superior  curved 
line  of  the  occipital  bone,  marking  the  separation 
of  the  occipital  lobe  from  the  cerebellum  by  the 
tentorium. 

The  fissure  of  Sylvius  is  indicated  by  a line 
starting  one  and  one-fourth  inches  behind  the  ex- 
ternal angular  process  of  the  frontal  bone  (E)  and 
ending  three-fourths  of  an  inch  below  the  center  of 


59 


the  parietal  protuberance  (f).  The  first  three- 
fourths  of  an  inch  is  the  main  fissure  at  the  end  of 
which  it  divides  into  the  ascending  branch,  which 
extends  upward  an  inch  from  the  horizontal  branch 
just  given.  The  division  is  beneath  the  anterior 
inferior  angle  of  the  parietal  bone.  The  motor 
speech  center  is  just  in  front  of  the  vertical  branch 
of  this  fissure. 

The  fissure  of  Rolando . Draw  the  lines  from 
(D)  to  the  bregma  (B)  and  from  (M)  to  (F). 
Perpendicular  to  the  base  line  (HL).  (F)  can 

also  be  located  by  taking  fifty-five  and  seven-tenths 
per  cent,  of  the  distance  from  (G)  to  (O).  The 
fissure  is  represented  by  a line  from  (F)  to  the  in- 
tersection of  the  fissure  of  Sylvius  with  the  perpen- 
dicular line  (DB). 

The  parieto-occipital  fissure  is  an  inch  long  and 
at  right  angles  to  the  longitudinal  fissure.  It  is 
one-fourth  of  an  inch  in  front  of  the  junction  of  the 
lambdoidal  and  inter-parietal  sutures,  and  is  about 
twenty-three  per  cent,  of  the  distance  from  (O)  to 
(G).  Also,  if  a line  corresponding  to  the  horizon- 
tal branch  of  the  fissure  of  Sylvius  were  extended 
to  the  longitudinal  fissure,  the  last  inch  would 
represent  the  parieto-occipital  fissure. 

These  primary  fissures  divide  the  outer  surface 
of  the  hemisphere  into  its  four  principal  lobes,  as 
follows  : The  frontal  lobe , which  is  limited  behind 
by  the  fissure  of  Rolando,  and  occupies  the  anterior 
fossae  of  the  bones  of  the  skull.  It  has  on  its  sur- 
face three  secondary  fissures  or  sulci.  The  first 
frontal  fissure  is  parallel  with  the  longitudinal  fis- 


60 


sure,  and  midway  between  it  and  the  temporal 
ridge  beginning  at  the  supra-orbital  notch  (S). 
The  second  frontal  fissure  is  approximately  repre- 
sented by  the  temporal  ridge  on  the  frontal  bone. 
The  precentral  fissure  begins  just  above  the  upper 
end  of  the  vertical  branch  of  the  fissure  of  Sylvius 
and  extends  half  way  to  the  longitudinal  fissure. 
It  lies  beneath  the  fronto-parietal  suture,  or  just 
behind  it.  The  frontal  convolutions  are  found  be- 
tween these  various  fissures. 

The  parietal  lobe  is  limited,  in  part,  by  the 
fissure  of  Rolando  in  front  and  the  parieto-occipital 
fissure  behind.  Of  its  four  convolutions,  the 
ascending  parietal  lies  behind,  and  parallel  with, 
the  fissure  of  Rolando;  the  supra-marginal,  around 
the  upper  end  of  the  horizontal  branch  of  the  fis- 
sure of  Sylvius;  beneath  the  parietal  eminence, 
and  a little  below  it,  the  perpendicular  line  (MF) 
separates  it  from  the  angular  convolution . 

The  inter-parietal  fissure  is  nearly  indicated  by 
a line  starting  on  the  fissure  of  Sylvius,  three- 
fourths  of  an  inch  behind  the  fissure  of  Rolando, 
running  parallel  with  the  longitudinal  fissure,  pass- 
ing within  one-half  inch  of  the  other  end  of  the  pa- 
rieto-occipital fissure. 

The  occipital  lobe  is  limited  above  by  the  pa- 
rieto-occipital fissure  extended  as  the  curved  line 
(a)  to  the  end  of  the  fissure  of  Sylvius.  It  is  ar- 
bitrarily limited  in  front  by  the  line  (C)  (b). 

The  temporo-sphenoidal  lobe  lies  in  the  middle 
fossae  of  the  skull  and  is  bounded  above  by  the  fis- 
sure of  Sylvius,  its  lower  border  corresponding  to 


61 


the  zygoma,  and  a line  continuing  it  to  the  superior 
curved  line  of  the  occipital  bone.  Its  anterior 
limit  is  the  posterior  superior  border  of  the  malar 
bone.  It  is  about  one  and  five-eighths  inches  wide 
at  the  meatus. 

The  first  temporo-sphenoidal  fissure  is  parallel 
with  the  fissure  of  Sylvius  and  an  inch  below  it. 

The  second  temporo-sphenoidal  fissure  is  three- 
fourths  of  an  inch  below,  and  parallel  with,  the 
first. 

The  posterior  limit  of  the  optic  thalamus  corre- 
sponds to  the  perpendicular  line  (MF). 

The  anterior  limit  of  the  corpus  striatum  is  a 
little  in  front  of  a vertical  line  from  the  beginning 
of  the  fissure  of  Sylvius. 

Of  the  fifteen  cerebral  venous  sinuses  only  two 
are  in  such  relations  to  the  skull  as  to  be  of  practi- 
cal importance  in  trephining  for  traumatic  or 
pathological  conditions. 

One  is  the  longitudinal  sinus  which  corre- 
sponds to  the  curved  line  (G)  (O),  but  it  is  slightly 
to  the  left  of  the  median  line  and  increases  in 
width  from  before  backwards.  The  other  is  the 
lateral  sinus , which  is  indicated  by  the  line  from 
(O)  to  the  auditory  meatus  and  corresponds  to  the 
superior  curved  line  of  the  occipital  bone.  It 
marks  the  inner  surface  of  the  tip  of  the  posterior- 
inferior  angle  of  the  parietal  bone.  Hemorrhage 
from  these  sinuses  is  a serious  complication  of 
wounds,  either  operative  or  accidental,  but  on  ac- 
count of  the  low  blood  pressure  in  them  is  easily 
arrested  by  light  pressure  or  fine  cat-gut  suture — 


6? 


the  latter  being  difficult  to  apply  in  the  midst  of  a 
free  bleeding. 

The  middle  Meningeal  artery  is  the  chief  supply 
of  the  skull  and  dura  mater  and  is  the  only  artery 
to  be  avoided  in  operations  on  the  skull.  The  only 
part  of  it  likely  to  be  wounded  is  its  main  branch 
which  corresponds  to  the  middle  of  the  anterior-in- 
ferior angle  of  the  parietal  bone,  ascending  behind 
but  nearly  parallel  with  the  fronto-parietal  suture. 
The  next  large  branch  is  horizontal  and  corre- 
sponds nearly  with  the  second  tempero-sphenoidal 
fissure  (which  see).  Hemorrhage  from  these 
branches  is  annoying,  but  usually  not  serious,  as  it 
can  generally  be  arrested  by  the  usual  means — 
forci-pressure  is  often  the  best  means.  Still 
they  are  to  be  avoided  in  operations,  when  possible. 


THE  EYE. 

The  organ  of  vision  consists  of  the  Globe  and 
its  protective  organs,  as  the  Eyelids  and  the  Lach- 
rymal Apparatus. 

The  eyelids  are  two  elliptical  structures  con- 
sisting of  strata  of  different  tissues.  The  strata 
are  : 

I.  The  skin. 

II.  The  orbicularis  muscle , (4)  which  closes 
the  lids,  is  of  thin  pale  fibres,  and  supplied  by  the 
facial  nerve  as  one  of  the  muscles  of  expression. 
A thicker  part  of  this  muscle  surrounds  the  borders 
of  the  orbit. 

III.  The  tarsal  cartilage9  which  is  a rigid 

*3 


plate  of  connective  tissue  held  in  place  by  the  tar- 
sal ligaments,  which  extend  from  their  outer  border 
to  the  periosteum  of  the  orbit,  and  which  prevent 
pus,  in  suppuration  of  the  lid,  from  passing  back 
into  the  orbit. 

IV.  The  expanded  tendon  of  the  levator  pal- 
pebrae  (upper  lid  only). 

V.  Meibomian  ( sebaceous ) glands , (2)  whose 
ducts  open  on  the  free  margins  of  the  lid,  (3)  the 
fatty  secretion  of  which  prevents  the  overflow  of 
tears. 

VI.  Mucous  membrane  ( conjunctiva ),  which 
secretes  some  mucus,  but  mostly  tears. 

The  eyelids  contain  no  fat,  but  the  different 
strata  are  held  together  by  delicate  areolar  tissue. 
The  upper  lid  is  the  larger  and  more  movable. 
The  interval  between  the  two  lids  is  the  palpebral 
fissure . The  junction  of  the  lids,  at  the  ends  of 
the  fissure,  makes  the  inner  canthus  and  the  outer 
canthus . Near  the  inner  canthus,  each  lid  has  a 
papilla,  in  which  is  a small  opening  to  receive  tears, 
the  punctwn  lachrymale  (5). 

The  tear  apparatus  consists  of  the  lachrymal 
gland  (1)  situated  below  the  external  angular  pro- 
cess of  the  frontal  bone,  and  whose  excretory  ducts 
(eight  to  ten)  perforate  the  conjunctiva  on  the  un- 
der surface  of  the  upper  lid;  the  puncta  (5)  which 
are  the  outer  openings  of  the  canaliculi  (6)  (upper 
and  lower),  which  join  to  form  the  lachrymal  sac , 
from  which  passes  downwards  (7)  the  nasal  duct , 
opening  into  the  inferior  meatus  of  the  nose, 
towards  the  front.  The  upper  canaliculus  first  as- 


64 


cends  vertically,  dilates  into  a small  pouch,  and  then 
runs,  a quarter  of  an  inch,  transversely.  The  low- 
er descends  vertically,  at  first,  and  is  shorter  and 
thicker.  The  nasal  duct  is  three-fourths  of  an  inch 
in  length,  and  is  directed  downward,  backward  and 
slightly  outward. 

The  globe  is  held  in  its  place  in  the  orbit, 
chiefly,  by  the  four  recti  muscles  (8),  which,  with 
the  two  oblique , move  it  on  its  posterior  cushion  of 
fat,  as  a ball  and  socket  joint. 

(9).  Junction  of  cornea  with  (10)  sclerotic , 
which,  posteriorly,  is  continuous  with  the  fibrous 
covering  of  the  optic  nerve  derived  from  the  dura 
mater. 

(n).  Iris , which  contains  two  muscles — the 
circular  ( sphincter ),  which  surrounds  the  pupil, 
lying  near  the  posterior  surface,  and  is  supplied  by 
the  third  nerve;  and  the  radiating  muscle  ( dilator ), 
which  is  chiefly  supplied  by  the  sympathetic.  The 
iris  is  suspended  in  the  fluid  ( aqueous  humor)  which 
fills  the  space  between  the  cornea  and  the  lens. 
The  space  in  front,  the  anterior  chamber,  connects 
through  the  pupil  with  the  posterior  chamber. 

(12).  Ciliary  processes , radiating  folds  of  the 
choroid  (13)  sixty  or  seventy  in  number.  The 
ciliary  muscle  (muscle  of  accommodation)  is  a ring 
of  unstriped  fibres  placed  at  junction  of  iris  and 
choroid,  between  the  ciliary  processes  and  the 
sclerotic. 

(14).  The  retina , the  expansion  of  (15)  the 
optic  nerve. 


65 


HE  EAR. 


The  organ  of  hearing  consists  of  the  outer  car- 
tilaginous part,  the  Pinna;  the  External  Auditory 
Meatus;  the  Tympanum  or  Middle  Ear;  and  the 
Labyrinth  or  Internal  Ear,  comprising  the  Vesti- 
bule, Cochlea,  and  Semi-circular  Canals.  The 
pinna  is  composed  of  yellow  fibro-cartilage,  and  has 
a tubular  prolongation  inwards  to  form  a part  of 
the  meatus. 

(1) . — A sectional  view  of  the  bony  part  of  the 
external  auditory  meatus.  The  whole  canal  is  one 
inch  and  a quarter  in  length,  the  cartilaginous  por- 
tion forming  a little  less  than  one-third.  The  nar- 
rowest part  of  the  canal  is  about  its  middle. 
Hence  the  difficulty  of  extracting  foreign  bodies 
which  get  beyond  this  constriction.  The  direction 
of  the  canal  is,  at  first,  inward,  forward,  and  up- 
ward ; then  it  curves  slightly  downward.  The 
floor  is  a little  longer  than  the  roof,  owing  to  the 
tympanic  membrane  being  placed  obliquely. 

(2) . — The  m e mb r ana  tympanic  a thin,  semi-trans- 
parent, membranous  disc,  slightly  oval  in  shape, 
forming  a complete  partition  between  the  external 
auditory  canal  and  the  middle  ear.  It  has  a thin 
layer  of  true  skin  on  its  outer  surface.  Its  inner 
surface  is  lined  with  the  mucous  membrane  of  the 
tympanum.  It  is  supplied  with  sensation,  in  connec- 
tion with  the  auditory  canal,  by  a branch  from  the 
auriculo-temporal  of  the  third  division  of  the  tri- 
facial. 

(3) . — Inner  surface  of  membrana  tympani, 


66 


against  the  upper  half  of  which  lies,  vertically,  the 
handle  of  the  malleus  (4). 

(5) . — The  incus  or  anvil  bone. 

(6) . — The  stapes , or  stirrup  bone,  he  base  of 
which  is  attached  to  the  membrane  of  the  fenestra 
ovalis  on  the  inner  wall  of  the  cavity  of  the  tympa- 
num. From  the  anterior  wall  of  this  cavity  the 
Eustachian  tube  leads  downward,  forward  and  in- 
ward to  the  pharynx.  On  the  posterior  wall  are 
three  or  four  openings  which  convey  air  to  the 
mastoid  cells. 

The  internal  ear  consists  of  (7)  the  three  semi- 
circular canals  behind ; in  front,  (8)  the  cochlea ; 
and  the  vestibule,  a small  cavity  placed  between 

(7)  and  (8). 

(9). — Termination  of  the  auditory  nerve  in  the 
cochlea. 

The  cochlea  is  in  the  form  of  a snail  shell.  Its 
base,  one-fourth  of  an  inch  in  diameter,  corresponds 
to  the  bottom  of  the  internal  auditory  meatus — the 
apex  being  directed  outward  and  forward. 

The  auditory  nerve,  the  portio  mollis  of  the 
seventh  pair,  after  passing  down  through  the  inter 
nal  auditory  meatus,  divides  into  two  sets  o\ 
branches,  the  anterior  being  distributed  in  the 
cochlea,  the  posterior  in  the  vestibule. 


67 


- '•-'vr  -r 


PART  SECOND 


THE  MALE  AND  FEMALE  GENERATIVE  ORGANS 
— THE  FOETAL  CIRCULATION. 


BY 


J.  SUYDAM  KNOX,  A.  M.,  M.  D. 

Professor  of  Obstetrics  and  Diseases  of  Children, 
Rush  Medical  College, 

Consulting  Obstetrician,  Presbyterian  Hospital, 
Chicago. 


THE  MALE  GENERATIVE  ORGANS. 


INDEX  TO  SECTIONS. 

(1)  — Peritoneum. 

(2)  — Bladder,  Exterior,  (2')  Mucous  Coat, (2")  Mus- 

cular Coat. 

(3)  — Symphysis  Pubis. 

(4)  — Prostate  Gland,  (4')  Section  of 

(5)  — Vesiculae  Seminalis,  and  Vas  Deferens. 

(6)  — Rectum,  External  Coat. 

(7)  — Gians  Penis. 

(8)  — Penis,  (8')  Section  of 

(9)  — Corpus  Cavernosum. 

(10)  — Corpus  Cavernosum,  Section  of 

(11)  — Membranous  portion  Urethra. 

(12)  — Bulb  of  Urethra. 

(13)  — Cowper’s  Gland. 

(14)  — Spermatic  Vein. 

(15)  — Spermatic  Artery. 

(16)  — Vas  Deferens. 

(17)  — Ureter.  n 

(18)  — Spermatic  Cord. 

(19)  — Vertebra. 

(20)  — Testicle. 

(21)  — Epididymis. 

(22)  — Spermatic  Artery. 

(23)  — Spermatic  Vein, 


(24)  — Major  globe  of  Epididymis. 

(25)  — Internal  texture  of  Testis. 

(26)  — Structure  of  Corpus  Cavernosum. 

(27)  — Artery  of  Corpus  Cavernosum. 

(28)  — Dorsal  Artery  of  Penis. 

(29)  — Orifice  of  Ureter. 

(30)  — Vas  Deferens. 

(31)  — Epididymis. 

(32)  — Rete  Testis. 

(33)  — Globus  Major  Epididymis. 

(34)  — Seminal  lobules  of  Testis. 

(35)  — Fossa  Navicularis  Urethrae. 

(36)  — Corpus  Spongiosum. 

(37)  — Corpus  Spongiosum. 

(38)  — Membranous  Urethra. 

(39)  — Prostatic  Urethra. 


MALE  GENERATIVE  ORGANS. 

These  consist  of  the  penis  and  testes  and  their 
appendages.  The  penis  (8)  is  the  organ  of  copu- 
lation. It  consists  of  a body  (8)  and  glans  (7). 

The  body , at  its  base,  is  firmly  connected  to 
the  rami  pubis  by  fibrous  crura,  and  to  the  symphy- 
sis pubis  (3)  by  a suspensory  ligament. 

The  glans  penis  (7)  is  cone-shaped.  A verti- 
cal fissure,  at  its  summit,  is  the  orifice  of  the  ure- 
thra, called  meatus  urinarius.  The  base  of  the 
glans  is  a rounded  ridge  ( corona  gla?idis')  and  be- 
hind this  ridge  a deep  depression,  ( cervix ).  Buried 
in  this  depression  are  numerous  sebaceous  glands, 
secreting  an  odorous  matter.  Want  of  cleanliness 


causes  an  accumulation  of  this  secretion,  with  irri- 
tation. The  mucous  membrane  covering  the  glans 
penis  contains  no  sebaceous  glands,  but  has  on  its 
surface  a number  of  very  sensitive  papillae. 

The  body  of  the  penis,  when  flaccid,  is  cylin- 
drical ; when  erected,  triangular.  It  is  composed 
of  a mass  of  erectile  tissue  (26)  enclosed  in  three 
cylindrical,  fibrous  compartments.  Two  of  these, 
the  corpora  cavernosa  (9),  lying  side  by  side,  form 
the  upper  part  of  the  penis.  The  third,  the  corpus 
spongiosum  (36),  encloses  the  urethra  and  forms  the 
under  portion  of  the  penis. 

The  corpora  cavernosa  consist  of  a very  firm, 
highly  elastic,  fibrous  envelope,  which  contains 
meshes  of  fibrous  and  erectile  tissue  (10).  The 
union  of  the  corpora  forms  a groove  above,  in 
which  run  the  dorsal  vessels  (28)  of  the  penis,  and 
a deeper  groove  below,  in  which  lies  the  corpus 
spongiosum  enclosing  the  urethra.  The  arteries  of 
the  corpora  cavernosa  (27)  are  derived  from  the 
pudic . They  terminate  in  curling,  dilated  extremi- 
ties, (, helicine ),  which  allows  them  to  accommodate 
themselves  to  the  erection  of  the  organ  without 
stretching. 

The  corpus  spongiosum  receives  its  arterial 
supply  from  the  internal  pudic.  The  upper  portion 
of  the  penis  can  thus  be  erected  without  the  lower. 

The  penis  is  supplied  with  lymphatics.  Its 
nerves  are  derived  from  the  internal  pudic  and  hypo- 
gastric plexus. 

The  cutaneous  covering  of  the  penis  is  ex- 
tremely elastic,  like  that  of  the  scrotum.  It  is  finer 


and  of  darker  color  than  that  of  surrounding  parts. 
It  is  attached  loosely  to  the  penis  by  a connective 
tissue  which  contains  no  fat,  and  therefore  allows 
of  great  motion. 

It  is  possible,  in  performing  circumcision,  to 
draw  the  foreskin  so  far  forward  as  to  cut  off  the 
whole  skin  covering  the  penis.  It  is  therefore  nec- 
essary to  mark  the  line  of  incision  before  drawing 
forward  the  foreskin. 

The  urethra  (36,  38,  39)  is  the  canal  for  the  dis- 
charge of  the  urine  and  the  semen.  It  is  eight  or 
nine  inches  long,  and  extends  from  the  bladder  (2) 
to  the  fissure  of  the  glans  penis  (7).  From  the  lat- 
ter its  direction  is  practically  straight  until  it 
reaches  the  membranous  portion  (38),  when  it  be- 
gins to  curve  upward  and  forward  to  enter  the 
bladder.  Inflexible  catheters  and  sounds  are  made 
to  imitate  and  accommodate  this  curve. 

Anatomically,  the  canal  of  the  urethra  is  divided 
into  three  portions,  the  spongy  (36),  the  7nembranous 
(38),  and  the  prostatic  (39). 

Gonorrheal  inflammation,  at  times,  invades  the 
glandular  structures  of  the  prostate,  establishing  a 
most  intractable  disease. 

The  testicle  (20)  is  the  organ  of  seminal  secre- 
tion. It  lies  in  a special  cavity  called  the  scrotum, 
suspended  by  a collection  of  structures  called  the 
spermatic  cord  (18). 

The  scrotum  consists  of  three  layers,  namely,  the 
skin , the  tunica  fibrosa,  and  the  tunica  vaginalis. 
The  scrotum  contains  two  cavities — a right  and 
left — each  containing  a testicle,  and  each  communi- 


eating  with  the  abdominal  cavity  through  the  ingui- 
nal canal  (18).  The  nerves  and  blood-vessels  of 
the  testicle  pass  through  this  canal  and  constitute 
the  spermatic  cord.  The  cavity  of  the  scrotum, 
which  is  a serous  cavity,  may  be  filled  and  distended 
with  fluid,  as  a result  of  inflammation,  causing 
hydrocele . Through  the  inguinal  canal  also  a loop 
of  intestine  may  descend,  producing  inguinal  hernia . 

The  testicles  (20)  are  two  in  number,  a right 
and  left.  The  left  hangs  lower  than  the  right  to 
prevent  injury  when  the  thighs  are  brought  together. 
During  foetal  life  the  testicles  lie  just  below  the 
kidneys,  and  gradually  descend  to  the  inguinal 
canal  as  pregnancy  advances  to  term.  At  birth, 
the  testicles  should  be  found  in  the  scrotum.  At 
times,  one,  and  more  rarely,  both  remain  in  the 
abdominal  cavity.  Where  both  are  retained,  ste- 
rility generally  exists.  Absence  of  the  testicles 
( anorchus ) occurs,  rarely,  and  produces  impotence. 
The  testicles  often  become  diseased,  requiring  re- 
moval. This  operation  is  called  castration , and 
when  performed  on  both  sides,  unsexes  the  patient 
and  causes  impotence.  The  testicle  is  covered 
with  a fibrous  capsule  (20)  ( tunica  albuginea ), 
and  contains  a glandular  secreting  substance  (34) 
and  vessels  (25)  and  nerves. 

The  fibrous  capsule  of  the  testicle  is  covered 
by  the  tunica  vaginalis , which  is  adherent  to  it,  and 
also  invests  and  binds  to  the  testicle  the  epididymis . 
Beneath  the  tunica  albuginea  is  a fine  network  of 
blood-vessels  ( tunica  vasculosa ) which  supplies  the 
secreting  substance. 


Prolongations  inward  of  the  tunica  albuginea, 
called  septa , divide  the  substance  of  the  testes  into 
lobules.  These  lobules,  200  or  300  in  number, 
consist  of  two  or  three  convoluted  seminal  tubes  of 
a diameter  of  1-200  of  an  inch.  Each  lobule  is  en- 
closed in  a delicate  plexus  of  blood  vessels.  At 
the  apices  of  the  lobules  the  seminal  tubes  become 
straight  and  pass  upwards,  freely  anastomosing, 
finally  terminating  in  15  or  20  ducts  (32).  These 
ducts  perforate  the  tunica  albuginea,  carrying  the 
seminal  fluid  from  the  testes  to  the  epididymis  (33). 
Here  they  enlarge  and  become  very  much  convo- 
luted (33).  They  then  descend  downward  (31)  to 
the  base  of  the  testicle,  where,  by  union,  they  be- 
come one  tube,  the  vas  deferens  (30). 

Inflammation  of  the  epididymis  leads  to  tem- 
porary or  permanent  obliteration  of  the  vas  defer- 
ens, causing  temporary  or  permanent  sterility. 
The  vas  deferens  is  thus  the  final  outlet  of  the  se- 
cretion of  the  testes.  Commencing  at  the  lower 
part  of  the  epididymis,  it  ascends  along  its  pos- 
terior side  (30)  and  along  the  back  part  of  the  sper- 
matic cord,  until  it  reaches  the  inguinal  canal  (16). 
Entering  the  pelvic  cavity,  it  descends  along  the 
side  of  the  bladder  (2),  passing  downward  and 
backward  towards  its  base.  At  the  base  of  the 
bladder,  it  lies  between  that  organ  and  the  rectum. 
(6).  In  this  position  it  becomes  enlarged  and  sac- 
culated (5)  until  it  reaches  the  base  of  the  prostate 
(4),  where  it  narrows  and  unites  with  the  vesicula 
seminalis  (5)  to  form  the  ejaculatory  duct.  These 


ducts  run  forward  through  the  prostate  to  discharge 
the  semen  into  the  urethra  (38). 

The  seminal  vesicles  (5)  are  two  sacculated 
pouches  lying  on  each  side  of  the  base  of  the  blad- 
der, just  outside  of  the  vasa  deferentia.  They  act 
as  seminal  reservoirs.  They  may  be  felt  by  exami- 
nation through  the  rectum. 

The  blood-vessels  of  the  spermatic  cord  are 
the  spermatic  (22),  deferential  and  cremasteric  ar- 
teries, and  the  spermatic  veins  (23)-  The  spermatic 
veins  form  a plexus  of  vessels,  and  make  the  chief 
mass  of  the  cord.  They  often  become  varicosed, 
forming  what  is  called  varicocele . 

The  semen  is  a complex  fluid,  consisting  of  se- 
cretions from  the  testes,  prostate,  seminal  vesicles 
and  Cowper’s  gland.  Examined  under  the  micro- 
scope, it  is  found  to  contain  numerous  filaments 
possessing  rapid  undulatory  movements.  These 
are  called  spermatozoa . They  are  the  impregnating 
agents  of  the  semen.  Absence  of  them  in  the 
seminal  fluid  indicates  sterility. 

Acids  arrest  the  movements  of  the  sperma- 
tozoa. Alkaline  solutions  stimulate  their  motion. 
Acrid  vaginal  discharges  may  thus  be  a cause  of 
barrenness.  Menstrual  blood  and  alkaline  mucus 
discharges  from  the  womb  prolong  their  vitality. 
For  this  reason  they  have  been  found  in  motion  a 
week  after  coitus. 


THE  FEMALE  GENERATIVE  ORGANS. 


INDEX  TO  SECTIONS. 

(A)  — Meatus  Urinarius. 

(B)  — Labia  Minora. 

(C)  — Vagina. 

(D)  — Venous  Plexus  of  Bulb. 

(E)  — Glands  of  Deverney. 

(F)  — Anus. 

(G)  — Clitoris. 

(K)  — Fimbria  attached  to  Ovary. 

(L)  — Fimbriae  of  Fallopian  Tube. 

(M)  — Hymen. 

(N)  — Ligament  of  Ovary. 

(O)  — Ovary,  (O') — Section  of 

(P)  — Peritoneum. 

(Q)  — Ascending  Colon. 

(R)  — Rectum. 

(S)  — Sigmoid  Flexure. 

(T)  — Descending  Colon. 

(U)  — Uterus. 

(V)  — Pampiniform  Plexus. 

(W)  — Venous  Plexus  of  Uterus. 

(X)  — Parovarium. 

(Y)  — Internal  Os  Uteri. 

(Z)  — Arbor  Vitae  of  Cervix. 

(A') — Urethra. 


(Bi) — Bladder. 

(F  T) — Fallopian  Tube. 

(FT')- — Fallopian  Tube. 

(U') — Cavity  of  Uterus. 

(a)  — Decidua  Vera. 

(b)  — Decidua  Reflexa. 

(c)  — Chorion. 

(d)  — Amnion. 

(e)  — Foetus. 

(f)  — Umbilical  Cord. 

(g)  — Placenta. 

(h)  — Uterine  Sinuses. 

(i) — Mesentery. 

(k)  — Ileum. 

(l)  — Ileo-Caecal  Valve. 

(m)  — Ascending  Colon. 

(n)  — Caecum. 

(o)  — Orifice  Vermiform  AppendiXo 
(P) — Vermiform  Appendix. 

(i)  — Dorsal  Vein  of  Clitoris. 

(2)  — Veins  of  communication. 

(3)  — Isthmus  of  Bulb  and  Veins. 

(4)  — Bulb  of  Vagina  and  Veins. 

(5)  — Superficial  Perineal  Vein. 

(6)  — Pudic  Veins. 

(7)  — Pudic  Veins. 

(8)  — Pudic  Veins. 

(9)  — Pudic  Artery. 

(10)  — Transversus  Perinei  Artery. 

(11)  — Artery  of  Bulb. 

(12)  — Profunda  Artery  of  Clitoris. 

(13)  — Profunda  Artery  of  Clitoris. 


(r4) 

(15) 

(16) 

07) 

(18) 

(19) 

(20) 

(21) 

(22) 

(23) 

(24) 

(25) 

(26) 

(27) 


Pudic  Nerve. 

Pudic  Nerve. 

Pudic  Nerve. 

Crus  Clitoris. 

Muscles  of  Crura. 
Transversus  Perinei  Muscle. 
Superficial  Sphincter  Ani. 
Bulbo  Cavernosus  Muscle. 
Perineal  Fascia. 

Tuberosity  of  Ischium. 
Symphysis  Pubis. 

Poupart’s  Ligament. 
Superior  Spine  of  Ilium. 
Obturator  Membrane. 


FEMALE  GENERATIVE  ORGANS. 

The  female  generative  organs  are  divided  into 
two  groups  : the  external  and  the  internal . 

The  external  generative  organs  are  called  the 
pudenda  (pudere — do  be  ashamed),  and  comprise  : 
the  mons  veneris , labia  ?najora , labia  minora  (B), 
clitoris  (G),and  hymen  (M).  These  form  the  vulva 
or  orifice  of  the  vagina. 

The  internal  organs  comprise  : the  vagina  (C), 
uterus  (U),  Fallopian  tubes  (FT)  and  ovaries  (O). 

EXTERNAL  GENITAL  ORGANS. 

The  mons  veneris  is  a fatty  cushion  covered 
with  hair  after  puberty,  containing  sebaceous 
glands,  resting  upon  the  symphysis  pubis.  It  is 
the  base  of  the  external  abdomen  and  the  upper 
and  anterior  junction  of  the  labia  majora. 


The  labia  majora  (N)  are  two  longitudinal^ 
cegumentary  folds,  rounded  and  slightly  curved. 
They  bound  the  orifice  of  the  vagina  on  each  side, 
and  act  as  a sort  of  valve  closing  it — whence  the 
term  vulva.  Their  superficial  surface  is  true  skin 
sparsely  covered  with  hair.  Their  inner  surface  is 
mucous  membrane,  but  contains  sebaceous  instead 
of  mucous  glands. 

The  shape  and  size  of  the  labia  majora  vary 
with  age.  In  the  young  virgin  they  are  rounded 
and  firm,  completely  closing  the  vaginal  orifice. 
In  married  women,  who  have  borne  children,  they 
are  less  rounded  and  gape  apart.  In  old  age  they 
are  shrunken  and  wasted. 

The  labia  ?ninora  (B)  are  two  membranous 
folds  of  a shell  pink  color,  situated  between  the 
labia  majora.  Their  outer  surface  is  continuous 
with  the  labia  majora  and  their  inner  surface  with 
the  mucous  membrane  of  the  vagina  (C).  They  are 
also  called  nymphae , (goddesses  of  the  fountain),  be- 
cause they  were  supposed  to  direct  the  stream  of 
urine. 

Superiorly,  each  labium  splits  into  two  folds, 
one  of  which  passes  over,  the  other  under,  the 
clitoris  (G)  to  unite  with  the  corresponding  folds 
of  the  opposite  side.  Thus  are  formed  the  prae- 
puce  and  frenulum  of  the  clitoris.  Below,  the  labia 
minora  pass  around  the  orifice  of  the  vagina,  and 
unite  to  form  the  frenulum  vulvae , or  fourchette. 

The  clitoris  (G)  is  a small,  elongated,  spongy 
body,  lying  below  the  upper  junction  of  the  labia 
majora  (N).  It  is  hung  from  the  symphysis  pubis 


(24 ) by  a suspensory  ligament,  and  protrudes  from 
the  folds  of  the  labia  minora  (B).  It  resembles  the 
penis  in  possessing  crura,  corpus  and  glans,  lack- 
ing, however,  corpus  spongiosum  and  urethra. 

The  crura  (17)  are  long,  slender  processes,  of 
spindle  shape,  attached  to  the  rami  of  the  pubes 
(24),  uniting  to  form  the  corpus  or  body.  The  ex- 
tremity of  the  body  is  the  glans  (G),  of  a pale  red 
color,  and  covered  with  papillae.  These  contain 
nerve  endings  of  extreme  sensitiveness. 

In  a state  of  erection,  the  clitoris  measures 
less  than  an  inch  in  length.  This  erection  of  the 
clitoris  occurs  from  emotional  or  mechanical  ex- 
citement, and  is  due  to  the  filling  of  its  spongy 
\ody  with  blood  from  its  appropriate  vessels  (1), 
(12),  (13). 

The  meatus  urethrae  (A)  is  situated  about 
three-quarters  of  an  inch  vertically  below  the  clitoris 
(G).  It  is  the  lower  boundary  of  the  vestibulum , 
which  is  a space,  bounded  by  the  clitoris  (G) 
above,  the  labia  minora  (B)  at  the  sides,  and  the 
vaginal  orifice  below  (C).  The  meatus  is  sur- 
rounded by  a sphincter  muscle,  which  puckers  the 
mucous  membrane  and  serves  as  a guide  for  the 
introduction  of  a catheter.  The  urethra  is  larger 
and  shorter  in  women  than  in  men,  and  can  easily 
be  dilated  for  the  introduction  of  the  finger  into 
the  bladder. 

The  Hymen  (M). — In  virgins  the  anterior  ex- 
tremity of  the  vagina  is  closed  by  a double  fold  of 
mucous  membrane  called  the  hymen.  The  inner 
surface  is  a continuation  of  the  mucous  lining  of  the 


vagina  (C);  the  outer,  that  of  the  labia  minora  (B); 
between  these  layers  of  mucous  membrane  are  some 
connective  tissue,  muscular  fibres  and  bloodvessels. 
The  hymen  is  usually  crescentic  in  shape,  its  con- 
cave border  looking  upward.  There  are,  however, 
other  forms,  viz. : 

1.  Hymen  cribriformis,  with  a number  of  small 
openings. 

2.  Hymen  annularis,  where  it  is  like  a ring, 
with  the  opening  in  the  center. 

3.  Hymen  imperforatus,  when  there  is  no 
opening  at  all,  and  menstrual  blood  is  retained  after 
puberty,  requiring  surgical  interference. 

4.  Hymen  fimbriatus,  where  it  looks  as  if  the 
virgin  had  been  deflowered  and  the  hymen  torn. 
At  times,  there  is  no  hymen  at  all ; and,  again,  the 
hymen  may  be  so  distensible  that  coitus  can  take 
place  and  it  be  not  ruptured.  Absence  of  hymen  is 
therefore  no  positive  sign  of  coitus,  and  its  presence 
no  sure  proof  of  chastity;  while  the  hymen  fimbri- 
atus resembles,  but  is  no  proof  of,  laceration  from 
intercourse. 

INTERNAL  ORGANS  OF  GENERATION. 

The  vagina  (C)  is  the  canal  which  connects 
the  uterus  with  the  external  genital  organs.  Its 
walls  are  composed  of  mucous  membrane,  connec- 
tive, elastic  and  muscular  tissue,  and  in  its  upper 
portion,  posteriorly,  peritoneum.  Unless  artificial- 
ly distended,  Its  anterior  and  posterior  walls  lie 
in  contact.  The  anterior  wall  is  nearly  an  inch 
shorter  than  the  posterior  one,  whose  length  is 


about  three  and  a half  inches.  The  vagina  lies  be . 
tween  the  bladder  (Bl)  and  the  rectum  (R)  and  is 
closely  united  to  them,  forming  the  recto-vaginal 
and  vesico-vaginal  septa . The  upper  fifth  of  the 
posterior  wall  is  separated  from  the  rectum  by  a 
fold  of  peritoneum,  called  Douglas’  cul-de-sac. 
This  is  the  only  point  where  the  abdominal  cavity 
can  be  entered  from  the  vagina.  This  is  often 
taken  advantage  of  to  drain  the  abdominal  cavity 
after  laparotomies.  The  upper  part  of  the  vagina 
encircling  the  cervix  uteri,  and  attached  to  it,  is 
called  the  fornix . 

The  mucous  lining  of  the  fornix  is  comparatively 
smooth.  As  the  canal,  however,  is  descended,  the 
walls  thicken,  particularly  on  the  anterior  and  pos- 
terior aspects,  throwing  the  mucous  membrane  into 
folds,  and  forming  the  anterior  and  posterior  vagi- 
nal columns.  The  mucous  membrane  of  the  vagina 
is  also  covered  with  vascular  papillae  and  contains 
scattered  mucous  follicles,  whi'ch  keep  its  surface 
constantly  moist  with  an  acid  mucus. 

The  vagina  receives  its  blood  supply  from  the 
hypogastric , the  vesical , the  uterine , and  the  puden- 
dal arteries,  and  returns  the  blood  through  the  cor- 
responding veins,  which  form  a close  plexus  around 
it.  As  these  veins  have  no  valves,  and  anastomose 
freely  with  the  veins  of  other  pelvic  organs,  it  can 
readily  be  seen  that  any  disturbance  of  return  cir- 
culation will  impart  a purplish  color  to  the  vagina, 
and  it  will  be  congested,  by  the  congestion  of  any 
other  pelvic  organ.  Thus  when  pregnancy  causes 
descent  of  the  womb  and  disturbance  of  its  return 


circulation,  the  vagina  also  becomes  congested  and 
its  purplish  color  becomes  one  of  the  signs  of  preg- 
nancy. In  the  same  way  congestion  of  the  rectum, 
causing  piles,  will  also  congest  the  vagina  and  cause 
excessive  mucous  secretion  termed  leucorrhoea  or 
whites. 

The  uterus  (U)  is  the  organ  that  contains, 
nourishes,  and  finally  expels  the  foetus.  In  the 
virgin  it  resembles  an  inverted  wide-necked  flask. 
It  is  about  two  and  one-half  inches  in  length,  and  is 
divided  by  a well  marked  contraction  into  two 
nearly  equal  parts.  The  upper  half  is  called  the 
body , the  lower  the  cervix . The  body  is  egg- 
shaped,  but  flattened  in  front.  The  cervix  is  cylin- 
drical, with  a rounded  lower  extremity.  This  is 
surrounded  by,  and  protrudes  into,  the  vagina.  It 
possesses  an  oval  aperture,  leading  to  the  cavity  of 
the  womb.  This  opening  is  called  the  external  os, 
or  os  tincae  from  its  supposed  resemblance  to  the 
mouth  of  the  Tench. 

Maternity  changes  permanently  the  uterus. 
The  body  becomes  rounder  and  larger,  proportion- 
ately, than  the  cervix.  The  cervix  becomes  broader 
and  less  firm  at  its  apex,  and  the  external  os,  on 
account  of  lacerations  of  its  border  during  labor, 
becomes  a ragged  slit. 

On  making  a lateral  section  of  the  uterus,  its 
cavity  (U')  is  opened.  This  is  found  to  be  trian- 
gular in  shape,  with  convex  sides. 

The  base  of  the  triangle  is  the  fundus . 

At  the  two  angles  of  the  base  are  found  the 
fine  openings  (the  size  of  a bristle)  leading  into  the 


i 


Fallopian  tubes  (F  T').  The  apex  of  the  triangle  is. 
the  internal  os,  a round  orifice  sufficiently  large  to 
admit  a uterine  sound. 

The  canal  of  the  cervix  (Z), which  lies  between 
the  internal  and  external  os,  is  spindle  shaped.  Its 
inner  surface,  like  the  vagina,  possesses  an  anterior 
and  posterior  ridge,  called  arbor  vitae  (Z),  from  its 
resemblance  to  the  leaves  of  that  tree. 

The  position  of  the  uterus  in  the  pelvis,  and 
its  attachments,  allow  it  great  freedom  of  motion 

Its  lower  extremity  projects  into  the  vagina, 
its  anterior  surface  is  attached  to  the  bladder  (Bl). 
The  fundus  is  covered  by  the  peritoneum  (P)  which 
descends  over  the  body  of  the  uterus  front  and 
rear.  These  folds  of  peritoneum  meet  at  the  sides, 
covering  the  Fallopian  tubes  (F  T),  ovaries  (O), 
blood  vessels  and  nerves,  and  are  called  the  broad 
ligaments.  They  divide  the  cavity  of  the  pelvis 
into  two  nearly  equal  halves.  In  operations  for  the 
removal  of  the  uterus,  these  ligaments  must  be 
carefully  ligated  before  section. 

Two  other  folds  of  peritoneum,  carrying  with 
them  muscular  fibres  from  the  uterus,  pass  back- 
ward on  each  side  of  the  rectum  to  the  sacrum,  and 
form  the  sacro-uterine  ligaments.  Two  more  peri- 
toneal folds,  also  carrying  muscular  uterine  fibres, 
pass  forward  on  each  side  of  the  bladder  to  the  in- 
guinal canals,  and  are  called  the  round  ligaments 
of  the  uterus.  Cutting  down  on  the  inguinal  canal, 
and  drawing  out  and  shortening  these  round  liga- 
ments, is  called  Alexander’s  operation.  This  opera- 
tion corrects  retroversion  of  the  uterus. 


The  six  ligaments  thus  holding  the  uterus  in 
position  allow  of  much  extension ; so  that  for  sur- 
gical procedures  the  cervix  can  be  drawn  almost  to 
the  mouth  of  the  vagina. 

Relaxation  of  these  ligaments  causes  the  vari- 
ous displacements  of  the  womb. 

The  muscular  tissue  of  the  womb,  which  con- 
sists of  three  layers,  is  of  the  unstriped  variety  and, 
therefore,  involuntary  in  its  action. 

The  mucous  membrane  of  the  body  of  the  uterus 
is  soft  and  smooth.  It  is  filled  with  glands  which 
secrete  an  alkaline  mucus.  Between  these  glands 
is  an  abundant  capillary  network  of  blood  vessels, 
which  is  the  source  of  the  menstrual  hemorrhage. 

The  mucous  lining  of  the  cervix  is  yellowish-red 
in  color,  firm  and  ridged,  and  can  readily  be  dis- 
tinguished from  the  smooth  red  lining  of  the  body. 
Its  glands  secrete  an  abundant,  glairy  white  mucus 
— like  the  white  of  an  egg.  This  mucus,  in  chronic 
catarrhal  inflammation  of  the  membrane,  often 
causes  sterility  by  closing  the  cervical  canal  to  the 
spermatozoa. 

Th e Fallopian  tubes  (FT)  are  practically  continu- 
ations of  the  uterus.  Their  cavity  (F  T')  commu- 
nicates directly  with  the  uterine  cavity,  and  their 
mucous  lining  and  muscular  tissue  proceed  from  the 
latter  organ.  These  tubes  are  from  three  to  four 
inches  long.  As  they  proceed  from  the  uterus, 
their  canal  is  straight  and  narrow,  but  it  soon  be- 
comes sinuous  and  enlarged,  and  terminates  in  a 
fringed  (fimbriated)  extremity  (L).  One  fimbria, 
longer  than  the  others,  is  attached  to  the  outer 


border  of  the  ovary  (K).  During  ovulation  the 
fimbriae  apply  themselves  to  the  ovary,  and  estab- 
lish a continuous  canal  to  the  uterus  for  the  con- 
veyance of  the  spermatozoa  and  the  passage  of  the 
ovum. 

The  muscular  walls  of  the  tubes  are  of  invol- 
untary fibre  and  have  a peristaltic  movement. 

The  ovaries  (O),  two  in  number,  are  the 
analogues  of  the  testes  of  the  male.  They  lie  in 
the  broad  ligaments,  directly  below  the  Fallopian 
tubes  (F  T).  They  are  ovoid  in  shape,  about  one 
inch  long,  three-fourths  of  an  inch  wide,  and  a half 
inch  thick.  Each  ovary  is  attached  to  the  uterus 
by  a ligament  (N)  about  an  inch  long,  and  at  its 
opposite  extremity  to  one  of  the  fimbriae  of  the  Fal- 
lopian tube  (K).  On  section,  the  ovary  (O')  is 
found  to  contain  within  its  tunic  a central,  red, 
medullary  substance,  and  a surrounding  grey  corti- 
cal substance.  The  granular  appearance  of  this 
cortical  substance  is  due  to  a vast  number  of  vesi- 
cles called  Graafian,  after  their  discoverer.  Each 
vesicle  contains  an  ovum  which  is  susceptible,  on 
maturity,  of  impregnation  and  of  subsequent  de- 
velopment, in  the  uterus,  into  a foetus. 
Blood-Vessels  of  Uterus  and  its  Appendages. 

Arteries  : i.  Arteria  uterina  hypogastrica . — 

This  arises  from  the  hypogastric.  It  descends 
downward  to  reach  the  vagina,  then  bends  upward 
between  the  folds  of  the  broad  ligament  and  pur- 
sues a tortuous  course  along  the  sides  of  the  uterus. 

2.  Arteria  uieri?ia  aortic  a. — This  artery  springs 
from  the  aorta  about  two  and  a half  inches  above 


its  bifurcation.  It  descends  to  the  pelvis  with  many 
a spiral  curve,  and  then  ascends  between  the  folds 
of  the  broad  ligament  to  supply  the  fundus  of  the 
uterus,  Fallopian  tubes  and  ovaries. 

These  two  arteries  communicate  freely. 

The  circumflex  branch  uniting  the  arteries  of 
each  side,  and  placed  around  the  location  of  the 
internal'  os,  is  of  surgical  interest,  as  it  may  be 
wounded  in  lacerations  of  the  cervix,  or  in  opera- 
tions therefor.  The  blood  flows  from  two  plexes 
of  veins,  viz.: 

1.  Plexus  uterinus  (W). 

2.  Plexus  pampiniformis  (V). 

These  form  a close  net-work  of  veins  about  the 
uterus,  Fallopian  tubes  and  ovaries.  The  first 
empties  into  the  hypogastric,  and  the  second  the 
spermatic  vein. 

The  uterus  also  contains  an  abundant  supply 
of  lymphatics  and  of  nerves  of  sympathetic  origin. 

Development  of  the  Ovum. 

The  fecundation  of  the  ovum  takes  place  at  the 
surface  of  the  ovary  (O),  or  in  the  Fallopian  tube 
(F  T).  It  consumes  a week  in  reaching  the  cavity 
of  the  womb  (U').  During  this  time  the  uterine 
mucous  membrane  has  become  congested  and  thrown 
into  folds  (a),  within  one  of  which  the  impregnated 
ovum  is  soon  entangled  and  attached.  As  soon  as 
the  ovum  has  thus  secured  a lodgement,  the  uterine 
mucous  membrane  begins  to  enclose  it,  forming  a 
complete  envelope  about  it,  called  decidua  reflexa 
(b).  The  ovum  enters  the  uterine  cavity  enclosed 


in  its  vitelline  membrane , and  the  blastodermic  memm 
brane , resulting  from  fecundation ; subsequently 
the  allantois  spreads  itself  over  the  whole  interior  of 
the  globe  of  the  ovum,  carrying  with  it  the  blood- 
vessels of  the  growing  foetus.  At  this  stage  of  de- 
velopment, the  embryo  (e)  is  enclosed  in  the  de- 
cidua (b)  derived  from  the  mucous  lining  of  the 
womb,  and  the  chorion  (c),  (made  up  of  the  vitelline 
membrane,  the  blastodermic  membrane  and  the 
allantois).  Simultaneously,  a third  membrane  is 
developed  called  the  amnion  (d),  which  directly 
envelopes  the  embryo,  floating  in  a fluid  called 
amniotic. 

As  was  said  before,  the  allantois  (part  of  the 
chorion)  carries  with  it  the  blood-vessels  of  the 
embryo.  These  penetrate  the  chorion  and  enter 
the  decidua,  coming  in  contact  with,  but  not 
mingling  with,  the  maternal  blood.  This  develop- 
ment of  blood-vessels  on  the  surface  of  the  chorion 
makes  it  shaggy  (c)  in  appearance.  As  the  develop- 
ment of  the  embryo  progresses,  these  blood-vessels 
disappear  from  the  chorion,  except  at  the  point 
where  the  decidua  lies  upon  the  uterine  tissue  (c). 
This  becomes  the  site  for  the  future  development 
of  the  placenta  (g). 

The  placenta  (g)  is  the  organ  of  respiration, 
nutrition  and  excretion  of  the  foetus.  After  the 
allantois  has  spread  over  the  entire  inner  surface  of 
the  ovum,  it  extends  its  villi  into  the  decidua,  so 
that  nutrition  is  absorbed  by  the  embryo  from  the 
whole  surface  of  the  chorion.  With  the  enlarge- 
ment, however,  of  the  ovum,  the  decidua  reflexa 


becomes  thinned,  with  an  obliteration  of  its  vessels 
and  a corresponding  disappearance  of  the  villi  of 
the  chorion.  . Thus,  the  whole  process  of  exchange 
between  mother  and  foetus,  becomes  concentrated 
in  the  decidua  scrotina  (h).  This  is  the  site  and 
origin  of  the  placenta.  The  villi  of  the  chorion 
here  wonderfully  multiply  and  branch  out,  each 
villosity  being  followed  and  surrounded  by  a cor- 
responding development  of  maternal  vessels.  The 
placenta  (g)  may  then  be  defined  as  a mass  of  con- 
nective and  vascular  tissue  representing  the  site  of 
contact  of  the  maternal  and  foetal  circulations. 

The  pedicle  of  the  allantois  becomes  the  um- 
bilical cord  (f).  It  consists  of  two  arteries  (16)  and 
one  vein  (18)  embedded  in  a gelatinous  substance 
and  enclosed  in  the  amnion. 

During  the  ninth  month  of,  gestation,  the  tis- 
sue connecting  the  placenta  with  the  uterine  wall 
undergoes  fatty  degeneration,  so  that,  at  term,  it  is 
easily  separated. 

On  separation,  the  uterine  muscular  tissue  is 
laid  bare  and  its  blood-vessels  torn. 

The  foetal  circulation  is  entirely  independent 
of  that  of  the  mother.  At  no  time  do  the  vessels 
of  mother  and  child  communicate  directly  with  each 
other.  Thus,  a woman  dying  in  labor,  from  hemor- 
rhage, can  bring  forth  a vigorous  babe.  The  force 
maintaining  the  current  of  foetal  circulation  is  the 
foetal  heart.  The  peculiarities  of  the  foetal  circu- 
lation are  : 

j.  The  blood  does  not  go  to  the  lungs  for  the 


interchange  of  oxygen  and  carbonic  acid,  but  zc  :ae 
placenta. 

2.  A special  arrangement  of  vessels  to  accom 
plish  this,  viz.:  umbilical  cord\  (one  vein  and  two 
arteries),  ductus  venosus , foramen  ovale , and  ductus 
arteriosus. 

Starting  at  the  placenta,  the  red  arterial  blood 
flows  through  the  umbilical  vein  (18)  to  the  navel 
(17)  of  the  foetus,  and  then  upwards  (27)  to  the 
liver  (24).  Here  it  mingles  with  the  blood  of  the 
portal  vein  and  enters  the  ascending  vena  cava  (31) 
through  the  ductus  venosus  (29).  Entering 
the  right  auricle  of  the  heart,  much  of  it 
passes  through  the  foramen  ovale  directly  into 
the  left  auricle,  the  balance  passing  into  the  right 
ventricle  and  mingling  with  the  blood  from  the 
descending  vena  cava.  That  portion  which  passed 
into  the  left  auricle  goes  on  to  the  left  ventricle  and 
is  forced  into  the  aorta.  That  portion  which  en- 
tered the  right  ventricle  is  forced  into  the  pulmo- 
nary artery,  but  instead  of  entering  the  lungs,  goes 
through  the  ductus  arteriosus  (9)  to  mingle  with  the 
blood  from  the  left  side  of  the  heart,  the  mpper  ex- 
tremities and  the  head.  It  is  now  impure  blood. 
Descending  the  abdominal  aorta,  some  of  it  pro- 
ceeds to  the  lower  extremities,  but  the  most  of  it 
enters  the  hypogastric  arteries  (16),  springing  from 
the  internal  iliacs,  and  passes  through  the  navel  along 
the  umbilical  arteries  to  the  placenta.  It  is  thus 
seen  that  the  umbilical  arteries  carry  venous  blood 
to  the  placenta,  and  arterial  blood  returns  through 
the  umbilical  vein. 


After  the  birth  of  the  foetus,  and  the  tying  of 
the  umbilical  cord,  the  child  respires,  and  its  blood 
goes  to  the  lungs  instead  of  the  placenta  for  the 
interchange  of  gases.  The  supernumerary  vessels 
then  disappear.  The  current  stops  in  the  umbili- 
cal vein,  the  ductus  venosus,  and  the  ductus  arteri- 
osus, and  they  soon  shrivel  and  disappear.  The 
foramen  ovale  gradually  closes,  and  the  pulmonary 
arteries  enlarge,  bringing  the  circulation  to  its  final 
and  appropriate  channels. 


ADDENDA. 


INDEX  TO  SECTIONAL  VIEW  OF  FEMALE. 

1.  Abdominal  wall. 

2.  Omentum. 

3.,  Site  of  Cardiac  Orifice  of  Stomach. 

4.  Liver. 

5.  Diaphragm. 

6.  Suspensory  ligament  of  Liver. 

7.  Stomach. 

8.  Spleen. 

9.  Pancreas. 

10.  Descending  Colon. 

11.  Abdominal  Aorta. 

12.  13,  15,  22.  Peritoneum. 

14.  Section  of  transverse  Colon. 

16.  Pyloric  extremity  of  Stomach. 

17,  18.  Mesentery. 

19.  Small  Intestines. 

20.  Intestinal  section  at  Ilio-caecal  valve. 

21.  29.  Rectum. 

23.  Uterus. 

24.  Round  Ligament. 

25.  Sigmoid  Flexure. 

26.  Bladder. 

27.  Symphysis  Pubis. 

28.  Vagina. 


INDEX  TO  PLATE  OF  FOETAL 
ORGANIZATION. 


i,  2.  Left  and  right  sides  of  Heart. 

3.  Left  Auricle. 

4.  Descending  Vena  Cava. 

5.  6,  10.  Aorta. 

11,  1 2.  Left  Subclavian  vein. 

13,  14,  15.  Common,  internal  and  external  lilacs. 

16.  Hypogastric  arteries. 

17.  Navel. 

18.  27.  Umbilical  vein. 

20,  22.  Chorion. 

21.  Amnion. 

23.  Placenta. 

24,  25,  32.  Liver. 

26.  Gall  bladder. 

29.  Ductus  venosus. 

30.  Hepatic  vein. 

31.  Ascending  Vena  Cava. 

33.  Kidney. 

34.  Supra-renal  capsule. 


